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Elisha Bartlett, M. D. Professor of 
Pathological Jlnatomy in the Berkshire 
Medical Institution, 

Jacob Bigelow, M. D. Professor of Ma- 
teria Medica in Harvard University , 

A. Brigham, M. D. of Hartford, Con- 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 

B. H. Coates, M. D. one of the Physi- 
cians to the Pennsylvania Hospital. 

Reynell Coates, M. D. of Philadel- 

D. Francis Condie, M. D. of Philadel- 

William P. Dewees, M. D. Late Pro- 
fessor of Midwifery in the University 
of Pennsylvania. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of the State of 
South Carolina, 

GouvERNEUR Emerson, M. D. of Phi- 

Charles Evans, M. D. attending Phy- 
sician to the Friends^ Jlsylum, Frank- 

John D. Fisher, M. D. of Boston, 

E. Geddings, M. D. Professor of Patho- 
logy and Medical Jurisprudence in the 
Medical College of the State of South 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 

R. E. Griffith, M. D. late Professor of 
Medicine in the University of Virgi- 

Thomas Harris, Surgeon U, S. Navy, 
and one of the Surgeons of the Penn- 
sylvania Hospital. 

E. Hale, M. D. Physician to the Mas- 
sachusetts General Hospital. 

George Hayward, M. D. Professor of 
the Principles of Surgery and Clinical 
Surgery in Harvard University, Bos- 

Hugh L. Hodge, M. D. Prof, of Mid- 
wifery in the University of Penn. 

T. S. Kirkbride, M. D. (^Philadelphia. 

C. A. Lee, M. D. of New York, 

Samuel Jackson, M. D.Professorofthe 
Institutes of Medicine in the University 
of Pennsylvania. 

Samuel Jackson, M. D. Philadelphia, 

William E. Horner, M. D. Professor 
of Jlnatomy in the University of Penn- 

Valentine Mott, M. D. Professor of 
Pathological and Operative Surgery in 
the College of Physicians and Surgeons, 
New York. 

Reuben D. Mussey, M. D. Professor of 
Surgery in the Medical College of Ohio, 

T. D. Mutter, M. D. Lecturer on Sur- 

G, W. NoRRis, M. D, one of the Sur- 
geons to the Pennsylvania Hospital, 

R. M. Patterson, M. D. Late Prof essor 
of Natural Philosophy in the University 
of Virginia, 

C. W. Pennock, M. D. one of the Phy- 
sicians to the Philadelphia Hospital, 


Physician to the Friends'* Asylum, 

Thomas Sewall, M. 1). Professor of 
Anatomy and Physiology in the Co- 
lumbian College, District of Columbia. 

AsHBEL Smith, M. D. Ex-surgeon Gene- 
ral of the Tcxian Army. 

Nathan R. Smith, Professor of the 
Practice of Medicine in Transylvania 
University . 

Thomas Stewardson, M. D. one of the 
Physicians to the Pennsylvania Hos- 

A. F. Vache, M. D. of New York, 

John Ware, M. D. Professor of the 
Theory and Practice of Physic in 
Harvard University, Boston. 

John C Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University , Boston. 

Edward Warren, M. D. of Boston, 

John Watson, M. D. of New York, 

G. B. Wood, M. D. Pnf essor of Ma- 
teria Medica and Pharmacy in the Uni- 
versity if Pennsylvania. 

Thomas H. Wright, M. D. Late Phy- 
sician to the Baltimore Alms-house In- 

EDITOR— Isaac Hays, M. D., one of the Surgeons to Wills' Hospital for the 
Blind and Lame, ^c. 





Vol. XXVI. 







tlBR^ .,/ 

Philadelphia : 

T. K. & P. G. Collins, Printers, 

No, 1 Lodge Alley. 






A Report of the Cases treated in Wills' Hospital by the Editor, during- the last 
quarter of 1839, will appear in the next No. It has been postponed to make 
room for the communications of our correspondents. 

The following works have been received: — 

Du Traitement Medical et Preservatif de la Pierre et de la Gravelle avec un 
Memoire sur les calculs de Cystine. Par Le Docteur Civiale. Paris, 1840. 
(From the Author.) 

An Inquiry concerning the Diseases and Functions of the Brain, the Spinal 
Cord and the Nerves. By Amariah Brigham, M. D. New York, 1840. — 
(From the Author.) 

An Introductory Lecture on the Anatomy, Physiology and Diseases of the 
Eye, delivered at the Birmingham Royal School of Medicine and Surgery, Oct. 
4, 1839. By Richard Middlemore, Surgeon to the Birmingham Eye Infirmary. 
London, 1839. (From the Author.) 

An Essay on the subject of Yellow Fever, intended to prove its Transmissi- 
bility. By B. B. Strobel, M. D., late Physician to the Charleston Marine 
Hospital. "Audi alteram partem." Charleston, 1840. (From the Author.) 

Memoranda for Practitioners in Midwifery. By Edward Rigby, M. D., &c. 
&c. First American Edition, with Additions, by S. C. Foster, M. D., Licen- 
tiate of the Dublin Lying-in Hospital, &c. New York, 1840. (From J. G. 

Annual Announcement of the Medical Department of Transylvania Univer- 
sity, containing the Circular for the ensuing Session, the Catalogue of Pupils, 
and the Graduating Class for 1839-40; and the Valedictory delivered to the 
Graduates on the day of (Commencement. (From Prof. T. D. Mitchell.) 

Valedictory Address to the Graduates of the Medical Department of Penn- 
sylvania College. By Wm. Rush, M. D., Prof, of Theory and Practice of 
Medicine. Philadelphia, 1840. (From the Committee of the Graduates.) 

Catalogue of the Trustees, Officers and Students of the University of Penn- 
sylvania. Philadelphia, 1840. (From the Dean of the Faculty.) 

Catalogue of the Officers and Students of the Medical College of the State 
of South Carolina, 1839-40. (From Prof. Dickson.) 

Seventh Annual Report of the Trustees of the State Lunatic Hospital at 
Worcester. Dec. 1639. Boston, 1840. (From L. Shattuck, Esq.) 

Second Medical Report of the Western Lying-in Hospital and Dispensary, 
31 Arran-Quay, from Nov. 1, 1836, to Dec. 31, 1837. By Fleetwood Chur- 
chill, M. D., Physician-Accoucheur to the Hospital, and Lecturer on Mid- 
wifery, &c. in the Richmond School of Medicine. Dublin, 1838. (From the 

Syllabus of a Course of Lectures on the Theory and Practice of Midwifery 
and on the Diseases of Women and Children, delivered in the Richmond Hos- 
pital School of Medicine. By Fleetwood Churchill, M. D., Licentiate of 
the King's and Queen's College of Physicians, &c. &c. Dublin, 1836. (From 
the Author.) 

On Uterine Leucorrhea and Researches on Operative Midwifery. By the 
same. (From the Author.) 

An Account of the Yellow Fever which appeared in the City of Galveston, 
Republic of Texas, in the Autumn of 1839, with Cases and Dissections. By 
Ashbel Smith, A. M., M. D., Ex-Surgeon General of the Texian Army. Gal- 
veston, 1839. (From the Author.) 

Eleventh Annual Report of the Inspectors of the Eastern State Penitentiary 
of Pennsylvania, Philadelphia, 1840. (From Dr. Darrach.) 


Report on the Condition of the Marine Hospital, with the number of Patients 
received, cured and died, from the 1st Nov. 1838, to 1st Nov. 1839. By B. B. 
Strobel, M. D., Physician. Cliarleston, 1839. (From the Author.) 

Spinal Irritation: its History, Diagnosis, Pathology and Treatment, illustra- 
ted by Cases. An Essay read before the New York Medical and Surgical So- 
ciety, Nov. 1839. By John H. Griscom, M. D. (From the N. Y. Journ. 
Med. and Surg.) New York, 1840. (From the Author.) 

The Annual Address to the Candidates for Degrees and Licenses in the Me- 
dical Institution of Yale College, Jan. 21, 1840. By Dyar T. Brainard, M. D. 
Member of the Board of Examination. Published by request of the Class. 
New Haven, 1840. (From the Author.) 

Catalogue of the Officers and Students of the Medical Institute of the city of 
Louisville, Jan. 1840. (From Prof. Short.) 

Annual Report of the Interments in the city and county of New York, for the 
year 1839, with accompanying Remarks. Presented by Wm. A. Walters, City 
Inspector. New York, 1840. (From Dr. C. A. Lee.) 

Address to the Graduates of the Medical Institution of Geneva College, de- 
livered Jan. 21, 1840. By Thomas B. Spencer, M. D., Prof, of the Institutes 
and Practice of Medicine. Published by request of the Graduates. Geneva, 
1840. (From the Author.) 

A Treatise on Scarlet Fever. By Dr. C. P. P. F. Reiersen. New York, 
1840. (From the Author.) 

Revue Medicale de Paris, October, November, December, 1839. (In ex- 

Bulletin General de Therapeutique Medicale et Chirurgicale, November, De- 
cember, 1839. (In exchange.) 

Journal de Medecine et de Chirurgie Pratiques, November, December, 1839, 
and January, 1840. (In exchange.) 

Journal des Connaissances Medicales Pratiques et de Pharmacologie, Novem- 
ber, December, 1839, and January, 1840. (In exchange.) 

Journal des Connaissances Medico-Chirurgicales, November, December, 

1839, and January, 1840. (In exchange.) 

Gazette Medicale de Paris, November, December, 1839, and January, 1840. 

(In exchange.) 

La LancetteFrangaise, October, November, December, 1839. (In exchange.) 

Journal de Pharmacie, December, 1839. (In exchange.) 

Zeitschrift fiir die gesammte Medicin, &c. Herausgegeben von J. C. G. 

Fricke und F. W. Oppenheim, November, December, 1839. (In exchange.) 
The Edinburgh Medical and Surgical Journal, January, 1840. (In exchange.) 
The British and Foreign Medical Review, January, 1840. (In exchange.) 
The Medico-Chirurgical Review, January, 1840. (In exchange.) 
The London Medical Gazette, for November, December, 1839, and January, 

1840. (In exchange.) 

The Medical Examiner for February and March, 1840. (In exchange.) 

The Western Journal of Medicine and Surgery, January, 1840. (In ex- 

The Select Medical Library and Eclectic, Journal of Medicine, February, 
March, and April, 1840. (In exchange.) 

The Boston Medical and Surgical Journal, February, March, 1840. (In ex- 

The American Medical Library and Intelligencer, February, March, and 
April, 1840. (In exchange.) 

The Maryland Medical and Surgical Journal, January, 1840. (In exchange.) 

The New York Journal of Medicine and Surgery, for April, 1840. (In ex- 

The India Journal of Medical and Physical Science, June, August, Septem- 
ber, October, and November, 1839. (In exchange.) 

The India Review and Journal of Foreign Science and the Arts, September, 
1839. (In exchange.) 




I. Report of a Series of Experiments made by the Medical Faculty of Lan- 
caster, upon the body of Henry Cobler Moselmann, executed in the Jail 
Yard of Lancaster County, Pa., on the 20th of December, 1839. - 13 

II. Statistical Account of the Cases of Amputation performed at the Penn- 
sylvania Hospital from January 1, 1838, to January 1, 1840. By G. W. 
Norris, M. D., one of the Surgeons to the Institution. - - - 35 

III. Case of Absence of the Uterus in an Adult Female, with Remarks. 

By Samuel Chew, M.D., of Baltimore. 39 

IV. On the Immovable Apparatus, and its therapeutic application to various 
Surgical diseases. By William Holme Van Buren, M. D. - - 48 

V. Statistics of the Amputations of Large Limbs that have been performed 
at the Massachusetts General Hospital, with Remarks. By George 
Hay ward, M. D., one of the. Surgeons to the Hospital. - - - 64 

VI. On Retention of the Placenta. By Edward Warren, M. D., of Boston, 
Massachusetts. ---_.-_-_- 71 

VII. A case of Rigidity of the Lower Jaw, cured by division of the anterior 
portion of the Masseter muscle of the left side. By Thomas D. Mutter, 

M. D., Lecturer on Surgery, &c., ------- 88 

VIIL Case of Artificial Joint of the Fore-Arm. By Dr. P. Fahnestock, of 
Pittsburg, Pa. - - - 91 

IX. Cases of Hemeralopia cured by the Exclusion of Light. By W. L. 
Wharton, Surgeon United States Army. ------ 93 

X. Case of Calculus — Enlarged Prostate Gland — Thickened and Saccu- 
lated Bladder — Bifurcation of the Ureter — Abscesses in the Kidneys. By 
George Sutton, M. D., of Aurora, Indiana. - - - . -.94 


XL On Dyspepsia, or Indigestion. By N. Chapman, M. D., Professor 
of the Theory and Practice of Medicine in the University of Pennsyl- 
vania. (Continued from No. L, page 341.) ----- 97 


XII. Medical Institutions, Diseases, &c., at Athens and Constantinople. 

By Pliny Earle, M. D. - - 109 

XIII. Address to the Medical Graduates of the University of Pennsylvania, 
Delivered April 3, 1840. By Samuel Jackson, M. D., Professor of the 
Institutes of Medicine in the University. 114 




XIV. Elements of Physiology. By J. Muller,M. D., Professor of Anatomy, 
and Physiology in the University of Berlin, &c. 7>anslated from the 
German, with notes. By William Baly, M. D., &c. Parts 3, 4, pp. 
258, -210. - 126 

XV. A Treatise on the Nature, Symptoms, Causes and Treatment of In- 
sanity, with Practical Observations on Lunatic Asylums, and a Descrip- 
tion of the Pauper Lunatic Asylum for the County of Middlesex, (Eng.) 
at Hanwell; with a Detailed Accoun't of its Management. By Sir W. 
C. Ellis, M. D., Resident Medical Superintendant, and formerly of the 
Asylum, Wakefield. London: 1838. 8vo. pp, 344. - - - - 155 


XVI. An Inquiry concerning the Diseases and Functions of the Brain, the 
Spinal Cord, and the Nerves. By Amariah Brigham, M. D 12mo., pp. 
327. New York: 1840. 171 

XVII. New Remedies: the Method of Preparing and Administering them; 
their Effects on the Healthy and Diseased Economy, &c. By Robley 
Dunglison, M. D., M. A. P. S., Prof, of Inst, Med. and Mat. Med. in 
.Teff. Med. Coll. of Philada., &c., &c., &c. Philadelphia, 1839. Lea & 
Blanchard. 8vo. pp. 503. 172 

XVIII. System der Physiologic umfassend das allgemeine der Physiologic, 
die Physiologische Geschichte der Menschheit, die des Menschen und 
die der einzelnen organischen systeme im menschen, fiir naturforscher 
und aerzte bearbeitet. Von Dr. Carl Gustav Cams, &c., 2 vols. 8vo. 
pp. 372— 460. Dresden, 1838 and 1839. 

A System of Physiology, embracing General Physiology, the Physiological 
History of Man, and of his individual organs, for the use of Naturalists 
and Physicians. By Dr. C. G. Cams. 175 

XIX. Wenken en Meeningen omtrent Geneeskundige Staatsregeling en 
Algemeene Geneeskunde, onder medewerking van eenige Vaderlandische 
verzameld en Uitgegevendoor J. P. Heije, Practiserend Geneesher te 

Jahrbuck der Gesammten Staatsarzneikunde. Herausgegeben von Dr. C. 
F. L. Wilberg, Grossherzoglich, Mecklenberg-Strel Ober-Medicinalrath. 175 

XX. Annual Report of the Interments in the City and County of New York 
for the year 1839, with Accompanying Remarks. By William A. Wal- 
ters, City Inspector. New York. ------- 178 

XXI. De la Duree de la vie Humaine. Par le Docteur Bellefroid, a Has- 
selt. Bulletin Medicale Beige. Aug. et Nov. 1839. 

On the Duration of Human Life. By Dr. Bellefroid, of Hasselt. Brussels, 
1839, 179 

XXII. An Account of the Yellow Fever which appeared in the City of 
Galveston, Republic of Texas, in the autumn of 1839, with Cases and 
Dissections. By Ashbel Smith, M. D., Ex-Surgeon General of the 
Texian Army. Galveston, 1839. 12mo. pp. 78. - - - - 183 

XXIII. Dictionnaire Historique de la Medecine Ancienne et Moderne, ou 
Precis de THistoire Generale, Technologique et Litteraire de la Mede- 
cine, suivi de la Bibliographie Medicale du nix Neuvieme Siecle, et d'un 
Repertoire Biliographique par ordre de Matieres. Par M. Dezeimeris, 
OUivier (d 'Angers) et Rage-De Lorme Docteurs en Medecine. Paris, 
1828—1839. 5 vols. 8vo. . . 184 







Anatomy and Physiology. 


1. Two remarkable cases of Com- 
plete Absence of the Uterus. By 


Functions of the Brain. By M. 
Nonat. ... - 186 

Ad. Burggraeve. - - . 185 3. Prof. Schultz's Experiments on 
2. Experimental Researches on the | Digestion. ... - 186 

Pathological Anatomy and General Pathology. 

4. Dr. Simon on Diuresis as a Re- 
vulsive action in Diseases of In- 
fants. 190 

5. Remarkable Tendency to He- 
morrhage in a Family. By Dr. 

Du Bois. .... 192 

6. Ulceration of the Throat ex- 
tending to the Lingual Artery; 
death by Hemorrhage. By Dr. 
Duncan. - - - . 193 

7. Softeningof the anterior column 
of the Spinal Cord, in its cervi- 
cal portion. By Dr. Power. 193 

8. Fragililas Ossiurn. By Mr. 
Adams. .... 193 

9. Guyon on Living Worms under 

the conjunctiva of the Negro. 194 

10. Chronic Endocartitis with per- 
manent Patency of the Aortic 
Valves. By Dr. Corrigan. - 194 

Materia Medica and General Therapeutics. 

11. On the employment of a new 
Vegetable Monesia in Medicine. 
By Dr. G. J. Martin St. Ange. 

12. Latoar on Tannin in He- 


moptysis. ... - 201 
13. Utility of Nux Vomica in 
Various Forms of Paralysis. By 
M. Petrequin. - - - 201 

Special Pathology and Special Therapeutics. 

14. Pathology and Treatment of 
Diabetes. By Bouchardat. - 203 

15. On the Treatment of Acute 
Rheumatism by Opium. By Dr. 
Corrigan. - . - - 

16. Saline Enemata in Cholera. 
By Dr. Murray. . - - 

17. Incontinence of Urine. By 
Dr. Lendrich. ... 

18. On the Employment of Sea 
Salt (Chloride of Sodium) in 




Pulmonary Consumption, Scro- 
fulous Affections, &c. By M. 
Amedee Latour. ... 208 

19. Case of Scrofula cured by 
Chloride of Sodium. By M. A. 
Latour. . „ . . 409 

20. Ileus cured by Injection of 
Air. 210 

21. On a Peculiar Affection of the 
Uvula. By Mr. Edward Thomp- 
son. 210 




22. Use of Erg-ot to excite the 
Contractions of tlie Urinary 
Bladder in order to promote the 
Expulsion of Calculi. By M. 
Guersant. - - - - 210 

23. Epilepsy after an External In- 
jury cured by Trephining. - 211 

24. Insufflation of Mercurial Pow- 
der in the Treatment of FJxcori- 
ations of the Neck of the Uterus. 

By M. Trousseau. - - 212 

25. "Successful Treatment of Aortic 
Aneurism by Acetate of Lead. 

By MM. Dusol and Legroux. 212 

26. On the Treatment of Varix of 
the Inferior Extremities. 1. By 
Pins. 2. By Caustic Potass. 
3. By the combinations of these 
means. By M. Bonnet. - 213 

27. Rigidity of the Lower Jaw — 
Operation — Cure. By M. Dieu- 
lafoy. - - - - .-218 

28. Post-mortem Appearances in 

Primitive Iliac artery had been 
tied. 218 

29. Tumour of the Parotid Gland. 
Extirpation. By D. Brett. - 219 

30. Treatment of External Cancer 
by Ligature of the Vessels and 
Division of the Nerves supply- 
ing the diseased part. By M. 
Jobert. - - - - 220 

31. On a new Universal Inter- 
rupted Splint. By Alfred Smee, 
Esq. 220 

32. Hydrocele of the Neck. By 
MM. Fleury and Marchessaux. 222 

33. Brodie's Application to Blis- 
tered Surfaces. - - - 224 

34. Sir Astley Cooper on Disloca- 
tions of the Humerus and Frac- 
tures of the Head and Neck of 
that Bone. - - - - 224 

35. Extirpation of an Encephaloid 
Tumour of the Testicle weiffh- 

ing nine pounds. By M. Boyer. 227 

36. Venereal Excrescences treated 

by watery solution of Opium. 228 


37. Case of sudden and temporary 
occurrence of Presbyopia in a 
young Boy. By Dr. James 
Hunter. - - - - - 


38. Hydrochloride of Barytes in 
Scrofulous Ophthalmia. By Dr. 
Payan. 229 


39. Inversionof the Uterus during 
Parturition — Rupture of thePos- 
terior Parietes of the Vagina — 
Passage of the Fcstus through 

the Rupture. - - - - 229 

40. On the Influence of the Length 
of the First Stage of Labour on 
the Duration of the Second, and 
the Consequences to Mother and 
Child. By Dr. Fleetwood 
Churchill. - - - - 230 

41. Statistics of Labour. By Dr. 
Fleetwood Churchill. - - 231 

42. On the Position of the Pla- 
centa in the Womb. By Dr. 
Richard Doherty. - - - 233 

43. Case of complete Detachment 
of the Os Uteri. By Hugh Car- 
michael, Esq. - - - 236 

44. On Incision of the Os Uteri in 
cases of incarcerated Placenta. 

By R. F. Power, M. D. - - 237 

Medical Jurisprudence and Toxicology. 

45. Poisoning with Nitrate of Sil- 
ver, cured by solution of Com- 
mon Salt. - - - - 239 

46. Death by Poison. - - - 239 

47. Excoriation round the Throat 
of a still-born Infant, By Dr. 
Evory Kennedy. - - - 240 



Animal Chemistry. 


48. Sugar in the Blood and Urine of 
Diabetic Patients. By Muiler. 240 


49. On the CompoBition of Milk. 
By M. Donne. - - - 240 


50. Sir James Clarke's Statement 

of the Case of the late Lady 
Flora Hast^igs. - - - 241 


Case of Imperfect Vision, follow- 
lowinff a blow on the Eye — Ab- 
sence of the Crystalline Lens 
ascertained by Catoptric exami- 
nation. By James W. Kerr, 
M. D. 245 

Violent Symptoms from the Bite 
of a Rat. By Whitman Wil- 
cox, M. D. - - - - 245 

Tenotomy for Club Foot success- 
fully performed. By W. M. 
Ecxbert, M. D. - - . 246 

Case of Club Foot cured by Di- 
vision of I'endo Achillis. By 
Wm. D. Lyles, M. D. - - 247 

Case of Gun-shot Wound of the 
Head and Brain. — Recovery. — 
By H. Janson, M. D. - - 248 

Views and Treatment of an Im- 

portant Injury of the Wrist. — 
By J. R. Barton, M. D. - - 249 

The late Dr. Parrish. - - 253 

Notes on the Examination of the 
body of Dr. Parrish, March 19, 
1840, thirty-two hours after 
death. 256 

Tributes of Respect to the late Dr. 
Parrish. ^ - . > 253 

Complimentary Resolutions to Dr. 
W. W. Gerhard. - - - 260 

University of Pennsylvania. - 261 

Transylvania University. - 264 

Medical College of the State of 
South Carolina. - - - 264 

Medical Institute of the City of 
Louisville. - - . - 554 

Medical Institution of Geneva Col- 
lege. 264 

New Work. - - - - 264 


Page 71, line 2 from bottom for 15654, read 16654. 
" 73, "19 " after " are" insert o/Ven. 

" 77, " 12 " for " several" read se/ze^^. 

" 85, " 7 " for " hand" read Amt^. 

" 85, " 24 " for . insert , 

" 86, "14 " for "cited" read ca7«7ec?. 





Art. I. — Report of a Series of Experiments made hy the Medical Faculty 
of Lancaster, upon the body of Henry Cobler Moseljnann, executed in the 
Jail Yard of Lancaster County, Fa., on the 20th of December, 1839. 

Contemplating a series of experiments, upon the body of Henry Cobler 
Moselmann, who was sentenced to be hung on the 20th of December, 1839, 
for the murder of Lazarus Zellerbach, Doctor Washington L. Atlee called upon 
Anthony E. Roberts, Esq., sheriff of Lancaster County, on the 30th of 
November, and received from that gentleman, for purposes of science, entire 
control over the body of the criminal after execution, and permission to make 
such arrangements as were desired, provided they did not include any direct 
violation of law. 

In furtherance of this object, Dr. W. L. Atlee reviewed the experiments upon 
the body of Forster, by Aldani; on Clydesdale, by Dr. Ure; and on Williams, by 
Professors Mitchell and Horner. From these experiments, as reported, and from 
new suggestions which arose on examining them, a programme was prepared to 
guide us in our future operations. 

The matter was now suggested respectively to Doctors John L. Atlee, Ely Parry 
and Frederick A. Mughlenberg, and a correspondence was opened between Drs. 
Atlee and several medical gentlemen of Philadelphia, for the purpose of securing 
the necessary apparatus, and also of inviting them to be present at the experi- 

A meeting of the medical gentlemen of Lancaster was now called at the ofRce 
of Dr. J. L. Atlee, on the 11th of December, in order to combine the efforts of the 
faculty, and to mature all our plans in due time. The programme was laid before 
the meeting and duly considered, and among the suggestions not embraced in the 
catalogue of experiments, was one by Dr. George B. Kerfoot, that in instituting 
artificial respiration, the lungs should be inflated with oxygen gas. 

At this meeting, the following committees were appointed to carry out the pro- 
visions of the programme, viz: — Doctors A. M. Cassidy and W. L. Atlee, to make 
the observations before death; F. A. Mughlenburg and Francis S. Burrowes, both 

No. LI.-— May, 1840. 2 

14 Report of a Series of Experiments on the 

absent, during execution; John Miller and Henry E. Mughlenberg to institute arti- 
ficial respiration; G. B. Kerfoot and J. L. Atlee to conduct the dissections; W. L. 
Atlee, Wm. B. Fahnestock and Charles Herlst, absent, to manage the apparatus; 
E. Parry and Patrick Cassidy, to attend to the application of the galvanic poles; 
"Wm. B. Fahnestock, to make the phrenological examination; and J. K. Neff and 
J. Augustus Ehler, medical student, to record the results of the experiments. The 
meeting now adjourned until the evening of the 17th of December. 

Not receiving from Philadelphia any favorable reply respecting the apparatus, 
Dr. W. L. Atlee went there on the 15th of December, and received from the 
Medical Faculty of Pennsylvania College, the generous and unanimous offer 
of a new Galvanic battery, consisting of 200 pairs of WoUaston's plates. The 
programme being submitted to Professors George McClellan, W. R. Johnson, and 
J. K. Mitchell, the first named gentleman suggested our attention to the action of 
the penis, which suggestion was afterwards added to the programme, and the last 
gentleman, the use of nitrous oxide gas in artificial respiration. From further 
conversation with Professor Mitchell, Dr. Atlee was induced to arrange the order 
of the experiments somewhat differently, so as to complete most of the important 
experiments before the dissections were commenced. 

On the evening of the 17th of December, the physicians assembled again. Doc- 
tors Samuel Haines and John Leonard being now present. The new arrangement 
of the experiments was now adopted, and all matters arranged, preparatory to the 
meeting in the prison on the day of the execution; after which the meeting ad- 

On Frisday, the 20th of December, the following gentlemen, in addition to those 
above mentioned, met in the Lancaster prison, viz; — Prof. W. R. Johnson and J. 
K. Mitchell, Doctor W. Poyntell Johnston, and Messrs. Van Buren, Kerr, Weir 
and Lang, medical students from Philadelphia; Doctor Coates of Chester Co.; 
Doctors Bitner and Dare of Lancaster Co., and Dr. Abr. Carpenter, and Messrs. 
Carpenter, Landis, Kauffman, Cameron, Lenher, and Hostettor, medical students 
of Lancaster. 

Doctor Haines having been appointed moderator, the following additional 
arrangements were made. Professor Mitchell and Dr. W« L. Atlee were added 
to the committee to make observations upon the scaffold; Dr. Johnston was added 
to the committee on dissections; Professor Johnson and Dr. W. L. Atlee were 
appointed to collect the expressed air after execution; Mr. Wise, aeronaut, to take 
charge of the lever of the battery; Professor Johnson and Messrs. Cameron and 
Hostettor, to experiment with the electro-magnet; Messrs. Landis, Cauffman, 
Carpenter and Haldeman, to conduct the electrical experiments; and Professor 
Mitchell and Dr. J. L. Atlee, to institute the experiments of Doctors Pennock and 

This introduction, although not essentially connected with the experiments, 
will show that the whole matter was carefully matured, by a proper and deliberate 
organization of medical men, and, in consequence, will give character to the series 
of experiments, strengthen confidence in the correctness of the report, add weight 
to the evidence of facts, value to the inferences deduced from them, and will go 
far in establishing them as truths in science. 

The experiments, which follow, are given in connection with the pro- 
gramme, as being the most simple, concise, and satisfactory arrangement I 
could adopt in drawing up the report. 


'f*iiOdRAMMiii 1. — Collect a portion of expired air before execution, and 
secure it well in a glass-stoppered bottle. 

Experiment. — Thursday, December 19th, at 11 o'clock, A.M., Doctors 
IVashington L. Atlee and George B. Kerfoot collected sixteen ounces in bulk 

Body of a Criminal who had been hung. 15 

of expired air in two eight ounce vials, and secured them well with cork, 
sealing-wax, and soaked bladder. 

Prog. II. — Examine the general condition of the body. 

Exp. 1. — Thursday, at 11 o'clock a. m., the general condition of the 
body good, and with the exception of a short white fur upon the tongue, 
and a slight pain in the head, in perfect health. 

Exp. 2. — Friday, December 20lh, at 1 o'clock p. m.. Doctors John L. 
Atlee and Kerfoot report the general condition of the body in apparent 
health, excepting a similar appearance of the tongue. 

Note. — Cobler's health before this period was somewhat variable. Dr. 
Kerfoot says that he prescribed for him in two attacks of intermittent fever 
before his trial in August last, and Dr. A. M. Cassidy also reports that at this 
period of his confinement he was troubled with an eruptive disease. After 
his conviction. Dr. Cassidy visited him in several attacks of disease in the 
right side of his chest, the cause of which he could trace to large quantities 
of indigestible and stimulating ingesta. Cobler informed him that he had for 
several years been subject to eruptions of the skin, and also had repeated 
attacks of inflammation in the right side. 

The jailer says that, until his conviction, Cobler was kept on the ordinary 
allowance of the prison, with permission to range through the buildings and 
yard, and that after conviction he was confined in irons to the flioor of his 
room, and allowed to indulge freely in the use of Dutch wine, beer, and the 
grossest diet. 

Prog. III. — Take the temperature of the body, and the air surround- 
ing U- 

Exp. — Friday, 1 o'clock p. m. The temperature of the body, taken in 
the mouth, 82° Fahrenheit. Temperature of the room, 70° 5'. 

Note. — This experiment is imperfect in consequence of the bulb of the 
thermometer having been removed from the mouth before the mercury ceased 
to rise. The tube was attached to a metallic scale, which, evidently pro- 
ducing a disagreeable taste, was soon removed. 

Prog. IV. — Examine the state of the pulse, 

Exp. 1. — Thursday, 11 o'clock a.m. His pulse, examined after the 
above air was collected, and while he was in a sitting posture, was 80 
in a minute. Upon standing up immediately afterwards, it was 117 in a 
minute. Natural in every respect except its great excitability from motion. 

Exp. 2. — Friday, 1 p. m. Pulse varying from 80 to 90; 80 at perfect 
rest, 90 after coughing. 

Prog. V. — Examine the action of the heart and respiratory organs by 
stethoscope and other means, 

Exp. 1. — Thursday, 11 a. m. The pulsations of the heart were distin- 
guished by the ear in the whole praecordial region ; impulse slight, but 
distinct; sounds of the heart distinct and audible ; rythm perfect. 

16 Report of a Series of Experiments on the 

Sounds, by percussion on the anterior part of the chest, natural and 

Soon after sitting down the number of respirations were 21 in a minute, 
and their action natural. 

Exp. 2. — Friday, 1 p. m. First and second sounds natural ; impulse 
weak and quick; respiration natural. 


Prog. I. — Observe closely the action of the body in the agonies of 

Exp. — Friday, December 20th, at seventeen minutes past 2 o'clock, 
p. M. the drop fell. Two or three successive emprosthotonoid efforts of 
the body were the only motions observed. These spasms were confined to 
the muscles on the anterior part of the body, from the pelvis up, and they 
gave a gently swinging motion to the body. 

Three minutes after execution there was a slight spasmodic action, which 
was the last perceived. 

Prog. II. — Take the temperature of the body and the air surrounding it, 

Exp. — Fifteen minutes after 2 o'clock p. m. the temperature of the air 
was 33° Fahrenheit. 

Note. — The thermometer was influenced, in some degree, by the reflec- 
tion of the sun from the prison walls. Nine minutes after execution the 
temperature of the body, near the axilla, was 85° Fahrenheit. 

Prog. III. — Examine the state of the pulse. 

Exp. — Dr. Francis Burrowes reporting, and Dr. Frederick A. Mugklen- 
berg recording the results : 

3 minutes after execution, pulse 144 in a minute. 

31 u u a a 120 " 

4 " " " " 120 " 

5 " " " " 150 «* 

6 *' " " *' 150 " and scarcely perceptible. 
61 " " « " 155 " 

7 " " " " 155 " 

8 " *' " " imperceptible. 

8| " " " there is no pulse at the wrist. 

The following are results recorded also by Dr. J. K. Nefl*: 

4 minutes after execution, pulse 120 in a minute. 

5 " *' " " 150 " 

Prog. IV. — Examine the action of the heart and respiratory organs. 
Exp. — Professor J. K. Mitchell, of Philadelphia, reporting, and Dr. J 
K. Nefl* recording results : 

4 minutes after execution, sound of the heart obscure, rythm perfect. 
il " " *' heart less confused. 




























he following 






















Body of a Criminal who had been hung, ' 17 

5 minutes after execution, the pulsations of the heart are so frequent, that 
they cannot be counted. 

5| " " " the sounds of the heart are scarcely audible, 

and the pulsations very frequent. 

pulsations of the heart 120 in a minute. 
ii ii 132 " 

ii ii 60 " 

more sound than percussion of the heart, 
pulsations of the heart 60 in a minute, 
distinct as to sound, and no percussion, 
pulsations of the heart 54 in a minute, 
nothing audible, 
sound entirely gone, 
►rded also by Dr. F. A Mughlenberg : 
pulsations of the heart 120 in a minute, 
ii it 132 " 

ii ii 60 " 

a li 60 . " 

ii ii 54 " 

no audible sound. 
Prog. V. — Observe the action of the penis. 

Exp. — There was an ejection of fluid from the urethra, but no priapism. 
Note. — Before commencing the observations during the execution, the 
watches of the several reporters were compared. 


Prog. I. — Immediately on cutting down the body, and before loosen- 
ing the noose, perforate the trachea ivith a large trochar; then withdraw 
the trochar, insert a gum elastic tube within the remaining cunula, 
draw off a portion of air contained within the lungs, and secure it us 

Exp. — The body was taken from the scaffold, placed in a coffin, and 
conveyed to a room in the prison. It was then taken out of the coffin 
and placed upon a table insulated by wax, the noose remaining tight. 

Thirty-three minutes after execution Dr. J. L. Atlee perforated the trachea, 
and upon withdrawing the trochar, air rushed out through the canula. Pro- 
fessor W. R. Johnson and Dr. W. L. Atlee now collected twelve ounces in 
bulk of expressed air. About sixteen ounces of air in all were pressed 
from the chest. The air was collected in two eight ounce vials, corked 
and sealed with some water in them. 

Note. — In collec'ting the air, both before and after execution, the same 
tube was used, and the full of it, in both instances, of atmospheric air, or 
at least a mixture of it and the breath passed over into the vials in company 
with the air from the lungs. 


18 Report of a Series of Experiments on the 

Prog. II. — Relax the noose^ and convey the body to the place selected 
for further experiment. 

Exp. — Forty minutes after execution the noose was divided, and the 
body shifted to a more favourable position. 

Prog. III. — Attach a bellows to the loose end of the tube, or use Pen- 
nock'' s apparatus to establish artificial respiration, and continue it during 
the progress of the following experiments : 

Exp. — Forty-five minutes after execution, Doctors John Miller and 
Henry E. Mughlenberg commenced the use of Pennock's apparatus, but 
in consequence of the canula, into vi'hich the tube was inserted, being 
straight, and striking perpendicularly against the posterior wall of the trachea, 
artificial respiration was very imperfectly kept up. There was merely 
an inflation of the lungs by the bellows, without any corresponding egress 
of air upon compressing the chest. 

Prog. IV. — Simultaneously with artificial respiration commence the 
galvanic experiments with flat poles, taking notes of time and tempera- 
ture repeatedly. 

Note. — So soon as the galvanic experiments were commenced, the com- 
pression of the chest in artificial respiration was abandoned ; the inflation 
of the lungs by the bellows was continued during the few first experiments, 
and the apparatus afterwards removed. 

galvanic experiments before dissection. 

Prog. I. — Place the positive pole on the left side of the neck, and 
the negative pole under the left seventh rib, and also at times on the 
right, varying the positions of both poles without destroying their con- 
taut with the skin. 

Exp^ 1. — Forty-seven and a-half minutes after execution. Doctors Patrick 
Cassidy and Ely Parry having the two poles of the battery applied, 'the 
positive upon the left side of the neck, and the negative under the left 
seventh rib. Professor Johnson threw the fluid upon the plates, which was 
immediately followed by a spasmodic action of the muscles supplied by the 
respiratory nerves. 

Exp. 2. — Forty-eight minutes after execution, the positive pole being 
retained upon the neck. Professor Mitchell took hold of the negative pole 
and applied it to the epigastrium, breaking the circuit frequently by patting 
the skin with the pole. This produced a violent action of the pectoral 
muscles, and established the respiratory action, producing audible sounds 
of breathing, with corresponding motions of the mouth, opening and closing 

Exp. 3. — Fifty minutes after execution, the positive pole being retained, 
the negative pole was passed along the linea alba down to the pubis. As 
the pole descended, the respiratory action became stronger and stronger, 

Body of a Criminal who had been hung, 19 

and when below the umbilicus it became very powerful, particularly the 
expiratory efforts. The action of the respiratory organs was general, and 
air passed in and out of the lungs regularly. The mouth being closed, 
and a lighted candle held to the nose, the flame was blown out with 
force. This was repeated five times in quick succession. The candle could 
not be extinguished so long as the pole was applied above the umbilicus, 
but so soon as the skin was patted below the umbilicus, these marked 
results took place. There were regular inspirations and expirations, the 
flame of the candle passing in and out, so as to singe the hair in the nostrils. 

Exp. 4. — Fifty-seven minutes after execution. The positive pole being 
retained, the negative was removed to the anterior part of the left thigh. 
Applied to the upper third of the thigh, the same phenomena occurred as in 
experiment 3d^ accompanied with still stronger expiration; but below that 
point the respiratory muscles did not act well. 

Note. — The foregoing experiments were made with the whole force of 
the battery. The 5th, 6th and 7th experiments, which follow, were made 
by detaching the pole at the negative end of the battery, and diminishing and 
increasing the power, by carrying it along the plates. 

Exp. 5. — The positive pole being retained, and the negative placed 
under the left 7th rib, contractions of the muscles of the left side and face 

Exp. 6. — The positive pole was placed upon the right side of the neck, 
and the negative upon the abdomen, producing strong contractions of the 
muscles of the face, and of the pectoralis major. 

Exp. 7. — One hour and one minute after execution. The 6th experi- 
ment having been repeated, it was ascertained that the muscular contrac- 
tions commenced at the 23d pair of plates, and that as the force of the battery 
was increased, the action of the muscles became stronger. The motion 
extended to the arm. 

Prog. II. — Eetain the positive pole on the left side of the neck, and shift 
the negative to the left iliac region. 

Exp. 1. — One hour and four minutes after execution. The whole force 
of the battery now being employed, there followed contraction of the muscles 
of the left thigh. 

Exp. 2. — The positive pole being retained, the negative was placed upon 
the right iliac region, and produced contraction of the muscles of the right 

Prog. \\\.— Retain the positive pole, and shift the negative to the great 
gluteal muscle over the sciatic nerve. 

Exp. I. — One hour nine minutes after execution. The muscles contracted 
strongly and threw the thigh outwards. 

Exp. 2. — The negative pole being shifted to the internal surface of the 
thigh, there was a slight contraction of the triceps adductor femoris. 

20 Report of a Series of Experiments on the 

Prog. IV. — Retain the positive pole, and shift the negative to the left 

Exp. — One hour fourteen minutes after execution. Contraction of the 
muscles upon the anterior part of the thigh. 

Prog. V. — Shift the negative pole to the left heel. 

Exp. — Not tried. 

Prog. VI. — Place the positive pole on the forehead^ over the supra 
orbital nerve, and the negative on the left side of the chest. 

Exp. — One hour twenty minutes after execution. All the muscles of 
the face were thrown into violent action; the angles of the mouth were 
drawn up, the eyelids closed with a tremulous motion; the occipito-fron- 
talis muscle was drawn down and put into action, giving motion to the scalp. 

Note. — In the contraction of the muscles of the face, in no instance was 
there an expression of passion, but merely a distortion of the countenance, 
which Professor Mitchell significantly termed grimace. 

Prog. VII. — Retain the positive pole, and shift the negative to suc- 
cessive spots on the arms. 

Exp 1. — The negative pole being placed on the skin over the biceps 
flexor cubiti of the left arm, the flexor muscles acted strongly, raising the 
arm to the chest. 

Exp. 2. — The negative pole, placed over the triceps extensor cubiti and 
upon the outside of the forearm, caused strong contractions in the extensor 
muscles of the wrist, with the corresponding motion of the hand. 

Exp. 3. — The negative pole placed upon the front of the forearm, produced 
strong flexion of the arm, and threw the hand upon the chest. 

Exp. 4. — The position of the negative pole being frequently varied, and 
applied in quick succession to diflferent spots, produced various move- 
ments of the hand and arm. The extensor and flexor muscles of the hand 
and fingers being stimulated in quick succession, gave a variety of rapid 
movements to the hand and fingers, sometimes clenching them, sometimes 
extending them, and sometimes acting on the index finger alone, giving a 
position to the hand resembling pointing. During the action of these muscles, 
the muscles of the face contracted slightly. 

Note. — In the clenching of the hand, above mentioned, the first phalanx 
of the fingers was extended, while the two terminal phalanges were flexed 
upon it. 

Prog. VIII. — Retain the positive pole and shift the negative to different 
parts of the face. 

Exp.-— One hour and twenty-eight minutes after execution. Irregular 
action of the lower jaw, masse ters acted strongly, compression and closing 
of the mouth, temporal muscles and orbiculares palpebrarum contracted 
firmly. When the negative pole was applied to the nose, the muscles of 
the face acted generally. 

Body of a Criminal who had been hung, 21 

Prog. IX. — Place the positive pole on the back of the neck, and run 
the negative along the leg. 

Exp. — One hour twenty-nine and a half minutes after execution. The 
negative pole being carried along the spine, the muscles of the back con- 
tracted. Placed upon the gluteal muscles, they acted powerfully, throw- 
ing the leg outwards. Placed upon the posterior part of the thigh, the foot 
was raised, and the leg flexed upon the thigh. Placed upon the calf of the 
leg, the soleus and gastrocnemii contracted with great power, throwing up 
the tendo Achillis forcibly and extending the foot. 

Prog. X. — Retain the positive pole; and shift the negative to the fore- 
head and parts of the face. 

Exp. — Those muscles of the face used in mastication were thrown into 
action, and simulated chewing. There was also a grinding motion of the 
jaw, and a motion of the lips as in tasting. 

Prog. XI. — Retain the positive pole, and shift the negative to the ham 
over the sciatic nerve. 

Exp. — The foot was raised, the leg flexed upon the thigh, and the foot 
extended. * 

Prog. XI. — Place the positive pole upon the epigastrium, and the 
negative upon the neck. 

Exp. — The scapular muscles, all the muscles of the shoulder, and the 
serratus magnus were excited. 

Prog. XII. — Repeat the few first experiments with points, and with 
the electro -magnet, and electrical battery, and if results should follow, re- 
peat the whole. 

Note. — This was postponed to a subsequent stage of the experiments. 


Prog. I. — Place the positive pole on the bed of the left par vagum 
and sympathetic nerves, and the negative in an incision below the cartilage 
of the left seventh rib, and to the parts heretofore touched, exposing them 
all by the knife, using the flat poles. 

Exp. 1. — One hour and thirty-four minutes after execution. The dissec- 
tions were conducted by Doctors Kerfoot and J. L. Atlee, and the parts 
being exposed, the poles were applied, but no results followed. 

Exp. 2. — The two poles now being shifted from the dissected parts 
to the sound skin over the same parts on the other side, there were also no 

Note. — The flat poles were now removed, and replaced by leaden points 
insulated both by oiled silk and glass. 

Exp. 3. — The descendens noni being in view, it was insulated upon 
the handle of the knife. The positive pole being applied to it, and the 
negative in the incision at the seventh rib, there were also no results. 

22 Report of a Series of Experiments on the 

Note, — The failure of these three experiments appearing extraordinar}', 
the cause was looked for, and the plates of the battery were observed not to 
be immersed. 

Prog. II. — Retain the negative pole in the incision under the seventh 
rib, and shift the positive upon the phrenic nerve exposed. 

Note. — The exposure of this nerve by dissection, having been deferred 
until many of the other experiments were completed; and a desire being 
expressed that the autopsy should be conducted by day-light, a want of time 
prevented this experiment from being tried. 

Prog. III. — Retain the negative pole, and shift the positive on the par 
vagum insulated. 

Exp, 1. — The plates being immersed, the negative pole was placed 
upon the epigastrium, and the positive as directed in the programme. Here 
followed slight contractions of the muscles of the face, of the side, and of the 
intercostal muscles. 

Note. — In applying the positive point to the insulated par vagum in the 
above experiments, a spark immediately ran off upon the nerve, producing 
an audible and a visible crisping of the Serve, with a rapid evolution of steam. 

Exp. 2. — The negative pole being detached from one end of the bat- 
tery and run along the plates, the above experiment was repeated. The 
results were similar to those which followed the same management of the 
negative pole in a former experiment. 

Prog. IV. — Retain the negative pole in the incision below the seventh 
ribf and shift the positive upon the sympathetic nerve insulated. 

Exp, — Not tried. 

Prog. V. — Retain the negative pole, and shift the positive upon the 
phrenic nerve insulated. 

Exp, — Not tried. 

Note. — The nerves upon the right side of the neck, now being exposed 
by dissection, the two following experiments were tried with the points. 

Exp, 1. — The positive pole was placed upon the right spinal accessory 
nerve, and the negative upon the epigastrium, and no effects followed. 

Exp, 2. — The negative being retained, the positive pole was placed 
upon the right descendens noni, and without any results. 

Note. — The eight following experiments were not made in the order of 
the programme, nor with any reference to its directions. The points were 
now replaced by the fiat poles. 

Exp. 1. — One hour and thirty-seven minutes after execution, the positive 
pole being placed upon the forehead, and the negative on the epigastrium, 
there followed a slight motion of the right side of the face, and the mas- 
selers acted strongly. 

Exp. 2, — The supra-orbital nerve now being exposed, above where 
it passes through the superciliary notch, and not insulated, the positive 


Body of a Criminal who had been hung* 23 

pole was applied to it, and the negative to the epigastrium; the results 
were the same. 

Exp. 3. — The positive pole was now placed upon the inner surface of 
the integuments of the forehead inverted, and the muscles of the face acted 

Exp. 4. — The flap now being replaced, the positive pole was placed 
on its cuticular surface, and the same parts contracted more strongly. 

Exp. 5. — The par vagum, on each side of the neck, now being divided, 
the positive pole was applied to the forehead, and the negative to the 
epigastrium, the results were the same as before the division. 

Exp. 6. — The lower portion of the divided par vagum of the right side, 
being lifted out of its bed by the forceps, and the positive pole applied to 
the cut end of the nerve, there was a slight contraction of the muscles of 
the right side of the face. 

Exp. 7. — The positive pole placed on the forehead, and the negative 
patted along the linea alba, down to the scrotum, produced slight contrac- 
tions of the muscles upon the fore part of the body. 

Exp. 8. — The positive pole being retained, and a point, substituted for 
the flat negative pole, being placed upon the epigastrium, no eflects fol- 

Exp. 9. — One hour and forty-one minuter* after execution. The positive 
pole being retained, the flat negative pole was again brought upon the internal 
surface of the left arm. The effects were firm contraction of the hand, and 
the forearm drawn to a right angle with the arm. 

Prog. YI.— -Expose the spinal marrow, by removing a portion of the 
atlas by bone forceps; place the positive pole on it, and the negative on 
the sciatic nerve, exposed beneath the great gluteal muscle. 

I^ote, — Nothing having been gained by insulating the nerves in previous 
experiments, it was considered unnecessary to expose the spinal marrow. 
The dissection, however, was prosecuted through the soft parts upon the 
back of the neck, for the purpose of passing the positive pole down to the 
spinal cord, just below the occiput. But upon probing with the finger the 
point where the atlas and dentata articulate, the dissectors discovered an 
unusual state of the parts, and which created some suspicion of dislocation. 
Considerable interest was excited in several of the medical gentlemen present, 
and the question of displacement not being settled, it was agreed to abandon 
that part of the neck for future examination, and to divide the spinal cord 
lower down. 

Exp. 1. — The spinal marrow was now divided between the third and 
fourth cervical vertebrae, and the sciatic nerve of the right side exposed 
beneath the gluteus maximus. The flat poles still being attached, the 
positive was passed in between the bones down to the divided ends of the 
cord, and the negative was placed upon the sciatic nerve, the pole being 

24 Report of a Series of Experiments on the 

also in contact with the divided fibres of the muscle. Contractions of the 
gluteus maximus resulted. 

Exp. 2. — The positive pole being retained, the negative was placed 
upon the skin over the great gluteal muscle, and this was followed by stronger 
contractions of the same parts. 

Exp. 3. — The sciatic nerve was now insulated upon the handle of the 
knife, and the negative pole brought in contact with it. The effects were 
not so strong, and were more local. 

Exp. 4. — The third experiment was repeated, observing how much 
of the pole came in contact with the nerve. Same results followed. 

Exp. 5. — The same extent of the negative pole was now brought in con- 
tact with the adjacent skin, and the result was precisely the same as in 
Experiment 4, 

Prog. VII. — Expose the cerebrum and cerebellum. Place the positive 
pole upon the upper surface of the corpus callosum, and the negative to 
the lower limbs and other parts. 

Prog. VIII. — Shift the positive pole to the posterior lobes of the 
cerebrum^ and use the negative as before. 

Prog. IX. — Shift the positive pole to the surface of the cerebellum, and 
the negative to the lower part of the back and to the penis. 

Prog. X. — Expose the medulla oblongata. Place the positive pole on 
it, and the negative on the sciatic nerve. 

Prog. XL — Vary the position of the positive pole on parts of the medulla 
oblongata, and also vary the negative pole. 

Note.^-T\\Q above five sections of the Programme were passed over for 
the same reason that prevented us from exposing the spinal marrow. 

One hour and fifty-nine minutes after execution. Desiring to examine 
the appearance of the viscera by day-light, the experiments were suspended 
until the contents of the abdomen were examined. The post-mortem dis- 
section for this purpose was conducted by Dr. W. Poyntell Johnston, a 
delegate from the Pathological Society of Philadelphia. The appearances^ 
will be given at another place, in the proper order of the programme. 

Prog. XII. — Expose the heart. »^pply the positive pole to the incision 
in the neck, and the negative to the external surface of the heart. Should 
the heart act well in this, or any of the following experiments, repeat 
the experiments of Doctors Pennock and Moore on animals. 

Exp. 1. — The positive pole being placed in the incision on the neck, 
and the negative upon the external surface of the pericardium, the muscles 
of the face moved, and the eyes opened and shut repeatedly. No action of 
the heart observed. 

Exp. 2. — The positive pole being placed upon the skin of the neck, and 
the negative retained, the same parts contracted, but with more force. No 
action of the heart; 

Exp. 3. — Two hours sixteen minutes after execution. The pericardium 

Body of a Criminal who had been hung. 25 

being opened, and the positive pole shifted to the right side of the face 
the negative was placed upon the external surface of the heart. The mouth 
contracted, but there was no action of the heart observed. 

Exp. 4. — The positive poles being retained, tlie negative was placed 
upon the external surface of the left ventricle. No action of the heart. 

Prog. XIII. — Puncture the descending cava. Pass the negative wire 
insulated into the cavities of the right auricle and ventricle. 

Exp. — The pulmonary artery being punctured, and the leaden points 
attached, the negative point was passed into the right ventricle, and the posi- 
tive placed upon the right side of the face. There followed a vermicular 
motion of the periphery of the right auricle. 

Prog. XIV. — Puncture the aorta. Pass the negative point into the 
left ventricle. 

Exp. — The same effects as in the last experiment. 

Prog. XV. — Reverse the poles. Exp. — Not tried. 

Prog. XVI. — Place the positive pole upon the spinal marrow^ and the 
negative in the heart. Exp. — Not tried. 

Prog. XVII. — Place the positive pole on the cerebrum and cerebellum, 
and the negative in the heart. Exp. — Not tried. 

Note. — Not being able to establish the action of the heart at this stage of 
the programme, the experiments of Doctors Pennock and Moore could not 
be repeated. 

Prog. XVIII. — Expose the abdominal viscera. Apply the positive pole 
to the sympathetic nerve in the neck, and the negative to the different vis- 
cera. Afterwards shift the positive to the several parts of the neck and 
head before touched. 

Prog. XIX. — Shift the negative to the diaphragm. 

Note. — In consequence of the post mortem examination having been 
made, the 18th and 19lh sections of the programme were abandoned. 

Prog. XX. — Expose the axillary plexus. Apply the positive pole to it, 
^and the negative to the different parts of the arm and wrist. 

Exp. — Not tried. 

Note. — Several of the experiments in the foregoing part of the programme 
"were passed over for want of time. 

Prog. XXI. — Repeat the experiments with other poles and other appa- 


Exp. 1. — Two hours and twenty-eight minutes after execution. The 
battery having been charged by Dr. W. L. Atlee, Mr. S. S. Haldeman 
applied the internal chain to the right side of the neck, and Mr. Henry Car- 
penter, student of medicine, applied the external chain to the right iliac 
region. The muscles on the anterior part of the ri-^lit thigh contracted upon 
the accession of the spark. 

No. LI.— May, 1840. 3 

26 Report of a Series of Experiments on the 

Exp. 2. — The same experiment was repeated with the same results. 

Exp. 3. — The internal chain was brought in contact with the right 
auricle of the heart, and the external with the apex of the heart. No con- 

Exp. 4. — The same experiment was about being repeated, but the 
internal chain touched the right shoulder, and the shock passed in that 
direction. No contraction. 


Exp. 1. — Two hours and thirty minutes after execution. Professor 
Johnson managed the machine, while Messrs. Cameron and Hostettor, 
medical students, applied the wires. One pole was applied to the right side 
of the face, and the other to the right iliac region. No results. 

Exp. 2. — One pole was applied in front of the ear, and the other upon 
the forehead. No results. 


After the body was removed from the scaffold to the room in the prison, 
and the face uncovered, there was observed no distortion of the features, no 
protusion of the tongue, nor any marked congestion of the face. 

One hour fifty-nine minutes after execution, Doctor Johnson commenced 
the examination of the abdominal viscera, and reported that on a superficial 
examination, the liver was enlarged and excessively congested, its convex 
surface having a marbled appearance, but otherwise healthy. The spleen 
was congested, and the intestines somewhat injected. In other respects all 
the abdominal viscera healthy. 

The stomach was removed and examined; it was natural externally, con- 
tained about two ounces of fluid, the rugse internally were very large but 
healthy, and the size of the stomach rather small. 

The liver being cut into, black blood ran out; it was excessively engorged 
with black blood; a small piece, taken into the hand and squeezed, the blood 
passed out as from a saturated sponge. , 

Dr. Johnson also examined the fluid ejected from the urethra. This was 
done immediately after stripping the body and before the experiments com- 
menced. The fluid was mucous, holding a few salts in solution, and con- 
taining no spermatic animalculae. The examination was made by Wollas- 
ton's Microscopic Doublet. 

As connected with the post-mortem appearances, although not examined 
with any pathological view, it may be observed that the pericardium con- 
tained about two drachms of fluid; the heart was of natural size and colour, 
and flaccid, containing no blood in any of its cavities. 

In the right cavity of the chest, there were firm adhesions between the 
two layers of the pleura. In the left cavity none existed. The lungs were 
apparently healthy. 

Upon puncturing the trachea with the trochar, no blood issued from the 

Body of a Criminal who had been hung, 27 

wound or from the canula. Nor was there any when the lungs were inflated 
by the bellows. So soon, however, as the respiratory action was established 
by the galvanic influence, there was a considerable discharge of frothy blood 
from the canula. 

The jugular vein having been accidentally cut while seeking for the par 
vagum, a large quantity of blood was discharged from it. 

Immediately after dividing the spinal marrow, there run out about four 
ounces of serous fluid, followed by an immense discharge of blood, which 
continued to flow for a considerable time after. 

With regard to the dislocation of the neck, Doctors Fahnestock and Ker- 
foot, who made the examination subsequently, reported that they discovered 
no dislocation of the cervical vertebree; no rupture of the transverse ligament; 
no fracture of the processus dentatus, and consequently there had been no 


The following report, drawn up by Dr. Fahnestock, and presented to a 
meeting of the physicians of Lancaster, was unanimously adopted, and 
ordered to be inserted into this part of the general report, viz: — 

^g-e, his own statement, 21. — Supposed to be 28 or 30. Temperament — 
Bilious Lymphatic. Size — About five feet ten inches. Figure — Very- 
broad, strong, and muscular. Eyes — Dark brown. Hair — Black. 

TAPE MEASUREMENTS — Of the. Head, the Hair being removed. 

Inches. Inches. 

Circumference of the head around Philoprogenilive- 

ness, Secretiveness, and Individuality, - - - Scalp 23. Skull 21.5 

Circumference of the head around Philoprogenitive- 

ness, Secretiveness, and Eventuality, ... 22.5 21. 


From Occipital Spine to Individualit}'^, . . - 8. 7.7 

From Philoprog-enitiveness to Individuality, ,. - . .. 7.9 7.6 

From Self Esteem to Individuality, .... 7.2 6.8 

From Ear to Individuality, ..... 4.8 4.6 

From Ear to Eventuality, 4.9 4.7 

" Comparison ...... 5. 48 

" Benevolence, ...... 5.4 5. 

" Reverence, ...... 5.4 5. 

" Firmness, 5.6 5.1 full. 

Self Esteem, 5.5 5.1 

" Inhabitiveness, ..... 5.4 4.8 

" Philoprogenitiveness, .... 5. 4.7 

" Amativeness, ..... 4.6 4.4 

From Cautiousness to Cautiousness. .... 5.7 5.4 

From Ideality to Ideality, 5.3 4.8 

From Constructiveness to Constructiveness, - - 5.4 4.5 


Report of a Series of Experiments on the 

From Destructiveness to Destructlveness, 
From Secretiveness to Secretiveness, 
From Aquisitiveness to Aquisitiveness, 
From Combativeness to Combativeness, 
From Alimentiveness to Alimentiveness, 



Scalp 6.1 

Skull 5.6 full, 


5.6 full. 







From the Ear, or Medulla Oblongata, to Alimentiveness, 

1 Alimentiveness, 






Amativeness, - 

3.9 full. 



























4.7 full. 


Self Esteem, 







4.9 full. 
























4.3 full. 



3.6 full. 






4.2 full. 










4. full, 


















4.6 full. 


Organ of Language, moderate. 
" Love of Life, large. 

The calliper measurements from the Occipital Spine to Individuality, 
Philoprogenitiveness to Individuality, Self Esteem to Individuality, and all 
the succeeding admeasurements from the ear to the organs which follow, 
together with those of the craniometer over the same points, were made to 

Body of a Criminal who had been hung, 29 

the centre of the front, top, and back parts of the head. The rest were 
taken to the centre of each organ, alike with both instruments. 

The measurements over the scalp and skull differ very little, except over 
the organs of Benevolence, Reverence, Firmness, Self Esteem, Inhabitive- 
ness, Philoprogeniliveness, Constructiveness, and Alimentiveness, where the 
integuments were unusually thick. 

The skull is of moderate thickness, except in the regions of Destructive- 
ness, Secretiveness, Alimentiveness, Cautiousness, Combativeness, Causal- 
ity, Imitation, Self Esteem, Amatlveness, Love of Life, and the site of 
Tune, where it is very thin, and if alighted taper be introduced into the 
skull, it is quite transparent over the above organs, whilst all the rest are 
dark, particularly over the regions of Reverence, Benevolence, Conscien- 
tiousness, Hope, Marvellousiless, Ideality, Constructiveness, Approbalive- 
ness, Inhabitiveness, Adhesiveness, and Philoprogeniliveness. 

These, I believe, are all the essential facts connected with his develop- 
ments, and as this paper is to accompany those of the experiments upon his 
body, I have refrained from any remarks upon his character, and shall 
close my report by stating that the measurements were taken in the presence 
of Dr. G. B. Kerfoot, to whom I am much indebted for many favours, and 
the free access which I at all times had to pursue my phrenological investi- 

I am, Gentlemen, yours very respectfully, 


To the Physicians of the City of Lancaster. 


Portions of air collected before and after execution were transmitted to 
Philadelphia for analysis. The following is an extract of a letter received 
from Professor W. R Johnson, containing the results of his analysis, viz. 

Med. Depart. Pennsylvania College^ Fhilad. Jan. 7, 1840. 
Dr. Washington L. Atlee, 

Dear Sir: 1 have received the two vials containing portions of the breath of 
Cobler, collected before and after execution respectively, and have submitted them 
to such examinations as the nature of the case seemed to require, in order to demon- 
strate the rehtive degrees of deterioration which they had suffered from the action 
of the lungs. 

In conformity with this purpose, I have sought to ascertain the relative propor- 
tions of oxygen, azote, and carbonic acid found in the two samples. 

1. The contents of the two vials were first placed in suitable receptacles over 
merrury, and subjected to the desiccating action of chloride of calcium for eighteen 

2. The air was next examined for carbonic acid, when it was found by exposure 
to pure potassa that the portion collected before execution lost 2.609 per cent, of 
its bulk by absorption of the potassa, while that taken from the lungs after execu- 
tion lost 7.7 per cent. 

3. The next step was to ascertain the proportion of oxygen and azote in the 
remainder thus freed from carbonic acid. For this purpose the method of detona- 
ting with hydrogen was employed. By three several trials on the breath taken 
before execution, I obtained a mean of 18.33 per cent, of the compound of oxygen 


30 Report of a Series of Experiments on the 

and azote for the proportion of the former ingredients, which is 17.84 per cent, of 
the original bulk of air before the carbonic acid had been separated. 

4. Deducing, by difference, the quantity of azote, the breath collected before 
execution, appeared to be composed of 

Oxygen 17.84 'parts 

Azote 79.551 " 

Carbonic Acid 2.609 " 


5. Three several attempts were made with breath collected after execution, to 
produce a detonation with hydrogen, but though the proportions of the hydrogen 
and air were varied to a great extent, no combination whatever could be effected. 

6. A portion of this air was next heated in contact with clean phosphorus, but 
though the latter was melted, and continued for several minutes in fusion, at a 
temperature which would inevitably have inflamed it, had oxygen been present, 
yet no signs of combustion were exhibited. 

Though these trials had convinced me that the breath taken after execution was 
wholly destitute of oxygen, yet I did not omit that very delicate test, furnished by 
the binoxide of nitrogen. A portion of this gas was therefore brought in contact 
with the air, but on several repetitions not the slightest change of colour was found. 

7. We are therefore warranted in the conclusion, that the air drawn from the 
trachea before loosening the noose, is composed of 

Carbonic Acid 7.7 
Azote 92.3 

Hemce it should seem that the portion of carbonic acid left in the air after stran- 
gulation, is not nearly the equivalent of the oxygen of pure atmospheric air. 
I remain very respectfully, your ob't serv't. 

Walter R. Johnson. 

The following are the detailed results of an analysis made by Dr. Wash- 
ington L. Atlee, of Lancaster, on portions of the breath taken from the same 
bottles which contained those in the above analysis of Professor Johnson. 

To the Medical Faculty of Lancaster, 

Gentlemen: — I herewith present to you my analysis of the breath of Cobler, 
both before and after execution. 

Breath after execution. — 1. I subjected 120 volumes of the breath collected 
after execution to the action of freshly fused chloride of calcium, for twenty hours 
over mercury, but observing moisture still adhering to the sides of the tube, I did 
not consider the air properly desiccated, and determined to make the necessary 
correction for vapour. 

2. I now prepared a stick of pure alcholic patassa from the vegetable caustic of 
commerce, and immediately after its consolidation, I placed it moistened within 
the air in the tube. The mercury in the Fahrenheit's thermometer stood at 53°, 
and in the barometer 29.70 inches. After several hours had elapsed, the potassa 
was replaced by a fresh portion, and was not withdrawn until after the expiration 
of 24 hours; 115 volumes remained in the tube, the thermometer standing at 62° 
F., and barometer 29.54. Now, making the necessary corrections for temperature, 
atmospheric pressure, and aqueous vapour, the original bulk of the air would be 
123.419877 volumes, and consequently the number of volumes absorbed by the 
potassa, would be 8.419877, which in the 100 parts, would make the proportion 
of 6.82214 volumes. 

The amount of carbonic acid gas, therefore, existing in 100 parts of the breath 
collected after execution, agreeably to the above results, would be 6.82214 volumes* 

Body of a Criminal who had been hung. 81 

The air thus deprived of its carbonic acid, was now subjected to a qualitative 
analysis for the purpose of detecting the presence of oxygen gas. 

3. A piece of potassium being introduced, its metallic lustre soon disappeared, 
and it became encrusted with white. After remaining in the air 4j hours, I re- 
moved it, and found it converted to a protoxide, excepting the central nucleus 
which preserved its metallic character. 

4. A piece of clean phosphorus was now passed into the same gas, and sub- 
jected to the heat of a spirit lamp. The phosphorus was fused, and kept in that 
condition for some moments. There w,as no ignition, but the fused phosphorus 
emitted a thin white vapour, and as the heat was not sufficient to volatilize the 
phosphorus, this effect must have proceeded from its union with oxygen. 

Having been convinced by these results, that the breath collected after execution 
contained an appreciable portion of oxygen gas, I now took another portion of the 
breath, in order to subject it to the quantitative analysis. 

5. For this purpose, I made use of Hare's aqueous sliding rod hydro-oxygen 
eudiometer and calorimotor, both constructed by Mason, of Philadelphia. Four 
successive trials were made with different proportions of hydrogen, and although 
in no instance was there any explosion or detonation perceptible^ yet in every 
instance, there followed a diminution of bulk in the air contained within the eudio- 
meter. The following are the respective experiments, viz.: 

Experiment First, — Breath 100 volumes; hydrogen gas 10; after ignition 3i 
volumes consumed. 

Exp. Second. — Breath 100 volumes; hydrogen gas 15; after ignition 3 volumes 

Exp. Third. — Breath 100 volumes; hydrogen gas 20; after ignition 3 volumes 

Exp. Fourth. — Breath 100 volumes; hydrogen gas 30; after ignition 3| volumes 

Now, taking the average of these four experiments, as the correct result, there 
would be a condensation of 3.20833 volumes of the mixture, which would give 
1.06944 volumes as the proportion for oxygen gas. 

The amount of oxygen gas, therefore, existing in 100 parts of the breath, collected 
after execution, agreeably to the foregoing results, would be 1.06944 volumes. 

6. Having derived the quantities of carbonic acid and oxygen gases by direct 
experiment, it is fairly inferred that the balance of the breath is nitrogen. 

As, therefore, the remaining air would amount to 92.10842 volumes, I am author- 
ized by the above analysis, in stating, that the breath collected after execution, is 
constituted of 

Carbonic acid gas 6.82214 parts 

Oxygen gas 1.06944 *' 

Nitrogen gas 92.10842 " 


Breath before execution. — 1. 103 volumes of the breath collected before 
execution, was placed over water, the thermometer standing at 63° F., and the 
barometer 29.44. A stick of clean phosphorus was introduced and permitted to 
remain for 12 hours. This was now exchanged for a fresh portion, and finding, 
at the expiration of 26 hours, that absorption had ceased for several hours, I fused 
the phosphorus without producing ignition or the evolution of white fumes, and 
then removed it. 91 volumes remained in the tube, the thermometer at 68° 5' and 
barometer at 29.34. Now making the corrections for temperature, atmospheric 
pressure, and aqueous vapour, the original bulk of the gas would be 104.140553 
volumes, and deducting l-40th of the bulk of the remaining 91 volumes for the 
vapour of phosphorus, which would reduce the air in the tube to 88.725 volumes, 
the number of volumes absorbed would be 15.415552, which in the 100 parts would 
make the proportion of 14.80168 volumes. 

The amount of oxygen gas, therefore, existing in 100 parts of the breath before- 
execution, according to the above results, would be 14.80168 volumes. 

84 volumes of the air thus deprived of its oxygen, were now placed over mer- 
cury in order to ascertain the quantity of carbonic acid gas. Thermometer 68°, 

33 JReporf of a series of Experiments on the 

barometer 29.27, and column of mercury within the tube, 2 7-10 inches above the- 
surface of the mercury outside the tube. 

'2. It was now subjected to the action of alcoholic potassa, as in the previous 
analysis, for 17 hours. It was then removed, and a solution of it was permitted 
to float above the mercury in contact with the air for 8 days longer. There now 
remained 80 volumes in the tube. Thermometer 63°, baromeler29.509 and column, 
of mercury in the tube 3 1-10 inches above the surface outside. The corrections 
being made for temperature, barometric pressure, nnd aqueous vapour would reduce 
the original bulk of air to 82.010933 volumes which would make a difference of 
.2010933 inches in the height of the mercurial column in the tube, before and after 
the experiment, and the necessary correction for this would reduce the 80 volumes 
remaining- in the tube to 79.450377 volumes, which deducted from the above 
original bulk as corrected, will give the true amount absorbed by the potassa, or 
2.5G0556 volumes. Now the proportion for 100 parts would be 3.122213 volumes. 

The amount of carbonic acid gas, therefore, existing in 100 parts of the breath 
before execution, according to the above analysis, would be 3.122213 volumes. 

3. In order to test the correctness of the quantitative analysis of the breath for 
oxygen gas, by means of the phosphorus, 1 next made five successive trials with 
Hare's eudiometer on fresh portions of the breath, varying the proportions of the 
mixture each time, as follows, viz.: 

Eccperiment i^ms^— Breath ICO volumes; hydrogen gas 60; after ignition 49 
volumes consumed. 

Exp. Second. — Breath 100 volumes; hydrogen gas 65; after ignition 50^ vol- 
umes consumed. 

Exp. Third. — Breath 100 volumes; hydrogen gas 75; after ignition 41| volumes 

Exp. Fourth. — Breath 125 volumes; hydrogen gas 75; after ignition 50^ volumes 

Exp. Fifth. — Breath 110 volumes; hydrogen gas 65; after ignition 47| volumes 

Now taking the average of the results of these five experiments, there would 
be a condensation of 44.92182 v.^lumes of the mixture, which would give 14.97394 
volumes as the proportion for oxygen gas. This result, I consider, as a remarka- 
ble approximation to the analysis by phosphorus, and comes far within the limits 
of the errors of observations. Taking now the average of the six separate analyses 
as the correct number, the amount of oxygen gas, existing in 100 parts of the 
breath collected before execution, would be 14.94523 volumes. 

4. The amount of carbonic acid and oxygen gases being known, the balance of 
the breath is put down as nitrogen. 

As, therefore, the remaining air would amount to 81.932557 volumes, theresults 
of my analysis of the breath before execution would be as follows, viz.: 
Carbonic acid gas 3.122213 parts 
Oxygen gas 14.945230 " 

Nitrogen gas 81.932557 " 


In connection with the chemical analysis, it is proper to observe that the crimi- 
nal had been confined for a considerable time in a close apartment, heated by an 
anthracite fire, and that the breath before execution was collected from him while 
in this apartment. It may also be stated, that both the air collected before and 
after execution, was confined in bottles containing water. How far these circum- 
stances may have affected the relative proportions of the constituents, it would be 
impossible now to determine, and yet they should be taken into the account in 
reviewing the above analysis. 

I would also observe, that in prosecuting this analysis, a tube, graduated for a 
rain guage, was employed, and that I contemplated repeating it with a regular 
eudiometer, but was disappointed in procuring one. I, however, submit it to your 
consideration, conscious of having given to the subject my" utmost care. 
Yours respectfully, 

Washington L. Atlee, M. D. 

Body of a Criminal who had been hung. 33 


Galvanic Battery. — The galvanic battery was procured for the occasion 
from the Pennsylvania Medical College, Philadelphia. It possessed con- 
siderable power, and was composed of 200 pairs of Wollaston's plates, and 
constructed on Professor Hare's plan of double trough and lever. The fluid 
used for exciting it, was composed of about 40 parts of water, and one part 
of sulphuric acid. The poles of the battery, were made of very thick leaden 
wire, soldered to strips of amalgamated copper at one end, upon which the axle 
of the trough rested, while the other, and free ends, were soldered to small 
hand vices insulated. Within these vices, we could attach pointed or flat- 
tened terminal poles at pleasure. The pointed poles were made of lead, and 
the flat poles of pieces of sheet copper, six inches long and two wide. A 
saturated solution of sal ammoniac was employed to wet the skin with. 

Electrical Machine. — This was a plate machine, two feet in diameter, and 
procured from the Lancaster Conservatory of Arts and Sciences. It is per- 
fectly insulated upon glass pillars, and acts well. 

Electrical Battery. — This battery is composed of three very large jars, 
placed in a truncated triangular tin box, and is coated with 3174 square 
inches of tin foil. The room being crowded for a long time before the elec- 
trical experiments were made, of course the battery could not be charged so 
strongly as in a perfectly dry atmosphere. 

Electro- Magnet. — This machine became disordered just before the ex- 
periments commenced, and could not be repaired in time to enable us to 
secure its full force. 

Table. — The table on which the body was laid, was a long box well insu- 
lated upon four stands of wax. During the galvanic experiments, however, 
the insulation could not be sustained, in consequence of the crowd pressing 
in against the table. In the electrical experiments this was satisfactorily 

Agreeably to an adjournment announced at the Lancaster prison, on Friday 
evening, a meeting of the physicians of Lancaster, was held at the house of Dr. 
Jno. P. Atlee, on Tuesday evening, December 24th, 1839, for the purpose of com- 
paring the notes of the gentlemen who recorded the results. The notes having 
been carefully revised, corrected, and unanimously adopted. Doctors Washington 
L. Atlee and Wm. B. Fahnestock were appointed a committee to draw up a report 
to present to a future meeting for consideration. 

Dr. W. L. Atlee offered the following preamble and resolutions, which were 
unanimously adopted, viz.: 

Whereas.) Anthony E. Roberts, Esq., sheriff of Lancaster County, having 
politely permitted the Medical Faculty of Lancaster, to institute a course of valu- 
able experiments upon the body of Henry Cobler Moselmann, and having cordially 
consented to every arrangement necessary to their successful performance, not 
inconsistent with the due execution of the laws, Therefore be it unanimously 

Resolved., That the thanks of the medical profession, and of men of science 
generally, are due to the sheriff of Lancaster county, for the facilities afforded by 
him in performing on the 20th instant a series of most valuable experiments on 
the body of the criminal Cobler. 

Resolved^ That medical and general science has been aided by the successful 
execution of the above experiments, and that executors of the laws in capital 

34 Report of a series of Experiments on the 

punishment, would be promoting useful knowledge by imitating the commendable 
example of the present sheriff of Lancaster county. 

Resolved^ That such a disposition of the body, by adding to our knowledge of 
the human system, would, in addition to the penalty of the law, be affording one 
of the best means of making restitution to society for the crimes of a murderer. 

Resolved^ That the medical gentlemen present at the execution of Cobler, 
return their thanks to Anthony E. Roberts, Esq., and cannot refrain from express- 
ing their admiration of the firmness, humanity, and strict regard for the laws, 
exhibited by him in the solemn and painful discharge of his duty. 

Resolved^ That a copy of the above resolutions be handed to the sheriff of Lan- 
caster county. 

Drs. W. L. A.tlee and John Miller, were appointed a committee to wait upon 
the sheriff with a copy of the foregoing resolutions. ^ 

Dr. John L. Atlee offered the following, viz.: 

Resolved, That the thanks of the physicians of the city of Lancaster, be pre- 
sented to Dr. Casper W. Pennock of Philadelphia, for his liberality in forwarding 
for their use his apparatus for artificial respiration, and for ascertaining the causes 
of the sounds of the heart. 

Resolved, That the thanks of the physicians of the city of Lancaster, be pre- 
sented to the Medical Faculty of Pennsylvania Medical College, for their'very 
generous loan of the galvanic battery of that institution, and more especially to 
Prof. W. R. Johnson, for the efficient aid rendered by him in the performance 
of the experiments. 

Dr. J. L. Atlee was appointed to communicate the above resolutions. 

I have now, gentlemen, concluded that part of the report, which, by a 
mutual arrangement of the committee, was allotted to me. Careful not to add 
or omit any thing contained in the original notes, which could in any way 
affect the character of the experiments as reported and recorded upon the 
spot, and equally careful to avoid the expression of an opinion respecting 
the experiments, and making deductions from them, I have given you no- 
thing more nor less than the naked facts themselves. However prolific in 
valuable truths the experiments may be, it is better to place them before the 
scientific world just as they are, than attempt to enlighten, or perhaps 
obscure them by any premature opinions. In this way they will be open 
to all, and the whole profession, including ourselves, can draw such inferen- 
ces, and cull such truths as the experiments may warrant. 

With many thanks for the honour you have conferred upon me, In placing 
me upon this committee, 

lam, gentlemen, very respectfully, your obed't serv't, 

Washington L. Atlee, M. D. 
To the Physicians of the city of Lancaster. 
Lancaster, January 17, 1840. 

The above report having been submitted to a meeting of the Medical gen- 
tlemen of Lancaster, held at the house of Dr. E. Parry, it was unanimously- 
adopted, and ordered to be offered to the editor of the American Journal of 
the Medical Sciences for publication. 

Norris^s Statistics of imputations, 35 

Art. II. — Statistical Account of the Cases of Amputation performed at 
the Pennsylvania Hospital from January 1, 1838 to Jan, 1, 1840. By 
G. W. NoRRis, M. D., one of the Surgeons to the Institution. 

In the Number of this Journal for August, 1838, I gave a statistical 
account of the cases of amputation performed in the Pennsylvania Hospital 
from the 1st of January, 1830, to the 1st of January, 1838. During the 
last two years an unusual number of amputations have occurred with us, 
and I herewith subjoin a tabular account of them, in continuation of that 
which has already been given. At the time of publishing my former tables, 
I expressed regret at being unable to procure accurate statements from any 
other large hospital in this country, wherewith our success in amputation 
might be compared, and am still sorry to find that but little attention is given 
to this matter. The subject of the mortality, after these very common ope- 
rations, is, however, beginning to attract notice abroad. For a long time 
past, Mr. Benjamin Phillips, of London, has had his attention directed par- 
ticularly to it, and at about the same time that ray paper was written, pub- 
lished an interesting essay in regard to it in the I^ondon Medical Gazette, 
June 9, 1838. The amputations included in the inquiry of Mr. Phillips, 
are those of the arm, fore-arm, thigh, and leg, all of which were performed 
in civil hospitals and in the private practice of hospital surgeons. The num- 
ber of cases collected by him is 640, embracing all cases, acute, chronic, 
and the results of violence which occurred in the practice of the persons by 
whom the returns were furnished within the period of four years. "Of 
these cases, 490 are reported cured, and 150 died, either in consequence of 
the operation or the progress of the disease, to rescue the patient from which, 
recourse was had to the operation. I apprehend, adds Mr. P., that a large 
number of our professional brethren are unprepared for such a result; I have 
only met with very few who were at all sensible of the extent of the mor- 
tality which occurs." 

As in England, most of our brethren in this country are totally unaware 
of the mortality which occurs after these operations, and some of our sur- 
geons, who are in the habit of giving the results of their practice from recol- 
lection alone, have received these statements with astonishment, and speak 
of their own success as being far greater than that shown by the statistical 
researches of Mr. Phillips, or furnished by the institution in which we have 
observed. That the success of amputations is greater in small towns and 
country practice, or even in the private practice of large cities, I firmly 
believe. In the small hospitals of cities, too, in which but a few surgical 
patients are collected together, the success after amputations may probably be 
greater than with us, though, in order to arrive at any thing like a true ave- 
rage of the mortality attendant upon these operations in any one institution, 

36 Norris^s Statistics of imputations. 

observations carried through a series of j-ears will be necessary. This neces- 
sity of extending any observations that may be made through a term of years, 
is strikingly shown by an inspection of the tables whioh I have made; in 
some years the mortality after these operations' being very small, while in 
others, though a similar class of cases have come under notice, and been 
subjected in every way to similar influences and treatment, the mortality has 
been large. From the 1st of January, 1830, to the 1st of January, 1832, 
but one death took place out of eleven amputations made during that period, 
while from the 1st of January, 1832, to the 1st of January, 1834, one-half 
of those amputated died (seven out of fourteen), and in the next succeeding 
two years the mortality became still greater, eight out of fifteen terminating 
fatally. From 1836 to 1838 the mortality then strikingly decreased, the loss 
being only one-third (five out of fifteen), and by the accompanying table it 
will be seen that, from the 1st of January, 1838, to the 1st of January, 1840, 
there has been but a single death out of twenty-four amputations, seventeen 
successive operations having had a favourable termination. To assert that 
death after amputation is rare with us, would be warranted by the experi- 
ence of the past two years, though undoubtedly it would be as far from 
giving a true idea of the danger of the operation, or of our average success, 
as to aver our ordinary results to be such as were had between the years 
1834 and 1836. 

I am myself inclined to the belief that the operations performed during 
the ten years past, will give a fair idea of the average success of the capital 
amputations had in the Pennsylvania Hospital, and as the principles laid 
down for the performance of them, dressings, class of patients, &;c., are 
nearly the same in all our larger cities, believe that it will be found to be 
near the true average of mortality after this class of operations, in the large 
public institutions in this country, and in such belief must continue, until 
their better success is shown by carefully prepared tabular statements of all 
their amputations, in place of the random guesses and vague recollections 
which are now brought forward in opposition to tabular statements, by the 
gentlemen diflfering from me in opinion. 

In the following table, all those amputations in which the operation was 
performed within twenty-four hours after admission, are included under the 
head of immediate, the patient in such cases having been brought to the 
house soon after the receipt of his injury. With one exception, the common 
circular operation was performed, and the stumps were all dressed so as to 
procure union by the first intention. The ordinary mode of dressing, is first to 
bring the flaps together by means of three or four long strips of adhesive plas- 
ter, and after covering the lips of the wound with lint spread with cerate, to 
apply a small cushion of charpie over the extremity of the stump, and to 
secure the whole with a bandage moderately tight. The first dressing was 
generally made on the third or fourth day, and repeated daily afterwards till 
cicatrization was complete. 

V- 2 
o ^ 
a, « 


January 24, 
February 28, 

April 11, 
April 25, 
September 12, 
October 6, 

November 7, 



February 13, 
February 16, 

August 31, 

October 2, 
October 16, 

-a o 

00 t-~^ « 


^^^ s s s 
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No. LI.— May, 1840 

38 Norris's Statistics of imputations. 

In adding the results furnished in the above tables to those given in the 
Number of this Journal already referred to, for the eight years previously, 
we arrive at the following results : 

Of eighty amputations on 79 patients, performed during a term of ten 
years at the Pennsylvania Hospital, thirty-five were primary, of which twen- 
ty-four were cured and eleven died, four of the deaths occurring within the 
twenty-four hours immediately following it. 

Twenty were secondary, of which thirteen were cured and seven died. 

Twenty-five* were for the cure of chronic aflTections, of which twenty 
were cured and four died. 

Thirty-two of the amputations were of the upper extremity, of which 
twenty-seven were cured and five died. 

Forty-seven were of the lower extremity, of which thirty-one were cured 
and sixteen died. 

Seven were amputations- at the joints, of which four were cured and three 

13 of the 79 operated on, were under 20 years of age, of whom 12 were cured and 1 died. 
26 were between 20 and 30, of whom 19 were cured and 7 died. 

22 were between 30 and 40, of whom 15 were cured and 7 died. 

16 were between 40 and 50, of whom 9 were cured and 7 died. 

2 were upwards of 50, • of whom 2 were cured. 

79 57 22 

The conclusions to be drawn from an analysis of the two tables which I 
have now published are, 

1. That amputation! with us is to be regarded as an operation attended 
with much danger to the life of the individual, the mortality after it being 
1 in 3-j-\. 

2. That the chances of success after it are much greater in persons who 
have been for some time suffering from chronic diseases, than in those who 
have it done while enjoying robust health, the mortality in the former class 
of cases being 1 in 6|, while in the latter it is 1 in S-^y' 

3. That immediate amputations after injuries are less fatal than secondary 
operations, the mortality after the former being 1 in 3j\, while in the lat- 
ter it is 1 in 2|. • 

4. That amputation of the lower extremity is much more fatal than that 
of the superior member, the mortality after the former being 1 in 2i|-, while 
in the last mentioned class of cases it is only 1 in 6f , and 

5. That the danger increases with the age of the individual operated on. 

* One double. 

t The great amputations only, it will be recollected, are alluded to. No death has fol- 
lowed any of the amputations of fingers, or toes, which have been made in the hospital 
during the ten years past. 

Chew's Case of Absence of Uterus in an Mult Female. 39 

Art. III. — Case of Absence of the Uterus in an Adult Female, with 
Remarks. By SamuI:l Chew, M. D., of Baltimore. 

I WAS requested, in January last to prescribe for R. H., an unmarried 
woman of about 22 years of age, who represented herself to be suffering 
from amenorrhoea. She stated that she had never menstruated, but that for 
several years past she had every month experienced the symptoms which 
are in many women the usual precursors of menstruation. She was annoyed 
at these seasons by headache, nausea, an uneasy tension of the breasts, pain 
in the back, and a sensation of fulness about the pelvis and lower part of the 
abdomen. These indications of indisposition, never violent, but yet trouble- 
some by their frequency of recurrence, continued generally for three or four 
days, and then gradually terminated without any excretion from the vagina, 
or a vicarious discharge from any other organ. She had never labored under 
any inflammation or painful affection of the sexual organs. Her general 
health, strength, and spirits had been uniformly good. Her countenance 
was marked by a feminine expression, her mammae were large and their 
glands fully developed, her hips broad, and her whole appearance that of a 
well formed, healthy female. 

From the regular occurrence of the catamenial effort, I concluded that 
there was no defect in the structure or functions of the ovaria. That the 
uterine secretion was not, after being formed, prevented from escaping by an 
obliteration of the os tineas, an imperforate hymen, or any other occlusion 
of the vagina, was evinced by the fact of the abdomen being entirely free 
from any abnormal distension. 

Under these circumstances, it appeared probable that the amenorrhcea 
depended upon some irregularity of formation, or morbid condition of the 
uterus. An examination was proposed, to which the patient consented. 
The external parts were of the natural form and size. The vagina, of the 
ordinary capacity in other respects, terminated abruptly, and without any 
previous diminution of its calibre, about an inch and a half above its orifice. 
The substance by which it was closed seemed to the touch — and to the eye 
when it was subsequently examined by means of a speculum — to be a con- 
tinuation of the walls of the organ, and possessed about the same degree 
of firmness and density. After a deliberate and very careful exploration, 
I was fully satisfied, tliat nature had in this case deviated from her usual 
plan, and produced a female in whom neither a uterus, nor any remnant 
or trace of that organ was discoverable. Aware of the infrequency of such 
a deficiency, and desirous to prevent doubts in the minds of others respecting 
the nature of this case, I sent the patient to the venerable Dr. Chatard, with 
a request that he would examine her. This gentleman who has so long 
stood preeminent in Baltimore as the unrivalled corypheus of obstetrical sci- 
ence, was unable by a most accurate investigation to find any vestiges of a 

40 Chew's Case of Absence of Uterus in an Adult .Female. 

uterus, and was convinced that the organ was wholly wanting. The woman 
was afterwards examined with great care, and with the same result, hy ray 
friend Dr. Cohen, and on another occasion by Dr. J. M. Smith, by neither 
of whom was the least doubt entertained respecting her condition. 

The mode of examination resorted to, was the following: A catheter being 
passed into the bladder and a finger into the vagina, they were brought as 
nearly into contact as the coats of the two organs would allow. In this 
manner it was easily ascertained that nothing was interposed between the 
lower part of the bladder and the anterior wall and upper extremity of the 
vagina. A similar investigation was made on the other side of the vagina: 
a finger of the left hand introduced into this organ, and one of the right into 
the rectum, were brought together as nearly as possible, along the posterior 
surface of the vagina, around its closed termination and between its anterior 
wall and the bladder. Finally, with a catheter in the bladder and a finger 
in the rectum the whole intervening space, both directly in the median line 
of the body and as extensively as possible on each side, was thoroughly 

The result of these researches was, not only that no uterus could be felt, ' 
but that the vagina terminated where it was closed, having no perceptible 
continuation of any description extending upwards into the pelvis. 

No tumour could be discovered in the hypogastrium. In examining this 
region, the woman was directed to breathe deeply, and the opportunity was 
seized of pressing the hand upon the abdomen during the ensuing expiration: 

The patient, on being questioned, admitted that she was very far from 
being deficient in sexual appetency. Cum viro semel (sic narrat) congressa 
est, et non sine voluptate vivida: amplexus tales, pietate monita, ut pluri- 
mum refugit, sed somniis amatoriis ssepenumero fruitur. 

The facts which I have stated appear, in the first place, to prove conclu- 
sively, that in the subject of this case the ovaria are present and efficient; 
and secondly, to make it higiily probable, if not absolutely certain, that the 
uterus is wanting. 

The presence and activity of the ovaria are sufficiently manifested by the 
regular occurrence of the catamenial excitement, and by the sensation of 
sexual appetite. 

That the venereal impulse depends upon the ovaria, we learn, both from 
comparative physiology which shows us that in the lower animals desire is 
extinguished by the loss of those glands, and also from the accounts of va- 
rious human females who have had them originally deficient, or been 
deprived of them by surgical operations. From this latter source, we derive 
the farther information, that in those who have been born without ovaria 
neiiher the catamenial secretion, nor any effort to accomplish that secretion, 
has ever been observed; and that such as have lost their ovaries after attain- 
ing adult age, have uniformly ceased to menstruate, however regular they 
may previously have been in the performance of the monthly function. By 

Chew's Case of Absence of Uterus in an Mult Female. 41 

the subjects of these cases, where the malformation is congenital, many of 
the peculiar anatomical and physiological characteristics of womanhood are 
never acquired; and where the dismemberment has happened later in life, 
they are in a great degree speedily lost. In the Transactions of the Royal 
Society, a case is related by Mr. Pears, of a woman, in whom upon dissec- 
tion, the ovaria were found to be so indistinct as rather to show the rudi- 
ments which ought to have formed them, than any part of their natural 
structure. This female, who died at the age of twenty-nine years, had never 
menstruated. Her os lincae and uterus, with the fallopian tubes which were 
pervious to their fimbriae, were found to have the usual form, but had never 
increased beyond their size in the infant state. Her breadth was fourteen 
inches across the shoulders, and only nine inches across the pelvis; her 
breasts and nipples had never enlarged more than in the male subject, there 
was no hair upon the pubes, nor had there been any indications of puberty 
either in mind or body; on the contrary, she always expressed aversion to 
young men who were too familiar with her.* In the well known case 
staled by Mr. Pott, \he woman whose ovaria he removed, though she con- 
tinued to enjoy good health, became thinner, and apparently more muscular; 
her breasts, which had previously been large, entirely subsided, and she 
never menstruated after the operation. In these instances, and in all others 
of a similar nature with which I am acquainted, the want of ovaria has been 
followejlDy consequences very widely different from any thing observed in 
the apwarance, or reported of the functions of the person whose case I have 
detailed, and I am, therefore, induced to believe, that she labors under no 
parallel deficiency of organization. 

The question of the presence or absence of the uterus, may, perhaps, be 
considered somewhat more doubtful and more difficult of solution. To pro- 
nounce of the patient, before she has been subjected to such an anatomical 
examination as can only be made after death, thai she is certainly destitute of 
a uterus, may possibly be deemed not perfectly warranted by the ascertained 
facts of the case. 

To this scruple, it may be replied, in the first place that if there be a 
uterus, it is unquestionably in a very unusual location, and probably of a 
size exceedingly minute and rudimental; farther, that if it exist, it must be 
totally deficient in the natural powers and properties of the healthy organ, as 
is evident from the absence of the catamenial secretion, notwithstanding the 
regular recurrence of the monthly constitutional excitement, and lastly, that 
however extraordinary the malformation may be thought, there are on record 
some other well attested cases of females, whose symptoms during life were 
not dissimilar to those of the person who forms the subject of the present 
account, and who were found after death to be destitute of wombs, though 
their ovaries were large, well- formed and perfect. 

* Philosophical Transactions, Vol. for 1805, p. 225. ^ 


42 Chew's Case of Absence of Uterus in an Adult Female, 

These considerations appear to me to render one of two conclusions 
respecting this case, inevitable; either the patient iias no uterus, or, if she 
has one, it is so undeveloped and imperfect as to produce no influence upon 
the rest of her organism. The former of these suppositions is in accordance 
with my own opinion, and with that of the other gentlemen by whom she 
was examined. 

I have thought the preceding case not unworthy of notice, in reference to 
its bearing upon the physiology of menstruation, and upon the laws of 
teratology or the doctrine of monstrosities; and also because similar instances 
of structural imperfection are extemely rare on the records of medical expe- 
rience, and have generally been related in a very imperfect and unsatisfac- 
tory manner. 

The important advantages to be derived in the study of physiology from 
the examination of cases of anomalous organization have, since the begin- 
ning of the last century, been fully known and admitted. We learn the 
functions of an organ, not only by observing the part it performs when pre- 
sent in the system, but also by noting the consequences of its absence. The 
instance we have been considering renders it evident that the excitement and 
increased vitality of the sexual organs by which menstruation is preceded 
are not dependent, as was once supposed, upon any congestion or distension 
of the vessels of the uterus, or upon any other change in the condition of that 
organ. It also rh.ows us, that the peculiar external characteristic*? of the 
female form, and the possession of sexual sensibility, are not at all Jiving to 
the uterus, and are in no way connected with its presence or development. 
Indeed, there can be no doubt, that the often quoted aphorism of Van Hel- 
mont — propter solum uterum mulier est id quod est — is perfectly erroneous, 
and that the distinguishing attributes of womanhood derive their origin not 
from the womb, but from the far more important energies of the ovaria. 

Is it possible for pregnancy to take place in a female, destitute of a uterus 
but possessing ovaries and a vagina? The affirmative of this question might 
be consistently maintained by the advocates of what is called the sympathetic 
theory of generation, who believe that the semen masculinum never passes 
beyond the vagina, but being brought into contact with some portion of that 
tube, produces there its specific impression, which is transmitted to the 
ovarian vesicle by sympathy or consent of parts. The same opinion might, 
on a difl^erent ground, be entertained by those who agree with the late dis- 
tinguished Professor of Midwifery in the University of Pennsylvania, that 
there is probably a more direct passage from the vagina to the ovaries than 
the one through the uterus and fallopian tubes.* An opposite conclusion 

*It was supposed that this doctrine derived support from Dr. Gartner's discovery, in 
several of the lower animals, of two small interrupted canals running from the ovaries, 
along the broad ligaments and the cornua and body of the uterus, to open into the vagina 
by the sides of the urethra. The same canals had been previously seen by Malpighi, 
and appear to hava been detected in the human subject by Madame Boivin. But the 

Chew's Case of Absence of Uterus in an Adult Female. 43 

will be embraced by those who recollect the experiments of Haighton and 
Blundell, by which it was shown that impregnation is uniformly prevented 
in rabbits, and probably in all other animals, by any interruption of the 
communication from the vulva to the ovaria, by means of division or ligature 
of the vagina, the fallopian tubes, or the neck of the womb. 

Modern investigations in the obscure and difficult but most interesting 
study of embryology have proved, that irregularities in the structure of the 
body are not occasioned by any original vice or defect in the germ, as was 
once contended by Winslow, but arise accidentally during the growth of the 
new being, and in the early periods of its uterine existence. Cases of mon- 
strosity from absence or imperfection of the uterus belong to Blumenrbach's 
class of monstra per defectum, or anomalies which spring from arrest or 
suspension of development. Their occurrence appears to illustrate the truth 
of the theory of the eccentric or centripetal formation §i the body, first 
advanced by M. Serres, and ably advocated by MM. Geoffroy and Isidore 
St. Hilaire. According to this view of the subject, which though not uni- 
versally applicable is yet undoubtedly true to a very great extent, the growth 
of the organs commences on the surface and progresses thence towards the 
interior of the system. The azygous or single organs, which occupy a 
situation directly in the median line of the body, are formed by the expan- 
sion of two lateral halves, at first separate and distinct, but which gradually 
approach each other, and are finally united. If by any cause the develop- 
ment of the rudiments of these halves be prevented, the organ is not formed; 
if the process of growth be interrupted before the two sides have been brought 
into contact and union, malformation and imperfection are the consequence. 
As might be expected from the mode and period of their formation, it has 
been ascertained by observation, that these organs are much less constant 
than the lateral and superficial ones, and that they are frequently absent, 
imperfect, and malformed, when the parts nearer to the surface are present 
and well developed. The female sexual organs may be divided into three 
principal segments, the first consisting of the ovaries and their appendages, 
the second of the uterus, and the third of the clitoris and vulva. These 
segments are to a certain extent independent of each other, are nourished 
and supplied by difl'erent sets of vessels, and it is not uncommon to see one 
of them undergoing modifications in form and structure, or even ceasing to 
exist, without any effect being produced upon the others.* At the first 
appearance of the genital organs, which is not until the sixteenth week of 
gestation, the rudiments of the ovaria consist, according to Meckel, of two 

researches of Rathke have shown them to be merely the remnants of two ductp, pervious 
in the embryo, and leading from the deciduous renal bodies the Corpora Wojffiana, which 
in all llie higher vertebratsB precede and form the first rudiments of the urinary and 
genital glands in the embryos of both sexes. 

* See Histoire generale et parliculi^re des Anomalies de POrganisation chez THomme 
et les Animaux, &lc. Par M. Isidore St. Hilaire: Paris, 1832-36. 

44 Chew's Case of Absence of Uterus in an Adult Female. 

elongated, narrow bodies, situated high out of the pelvis, and descending 
obhquely from without inwards, and from above downwards. Proceeding 
from above these, and extending on their outer side, are two long, attenuate 
canals, which uniting below compose the uterus and vagina, while their 
superior portion becomes expanded into fallopian tubes. After the process 
of growth has commenced in these rudimentary canals, and is advancing 
from the periphery towards the interior, should any cause arise to interrupt 
and obstruct the farther progress of development, the uterus, as the organ 
most deeply seated, will of course suffer most, and the parts of the vagina 
and tubes which are nearest to it will be more affected than those which are 
more remote, Thus the ovaries, the ovarian extremities of the tubes, and 
the lower portion of the vagina may be perfect, while the uterus and its 
immediate appendages are either extinct, or more or less deformed. 

What are thetagents capable of so affecting the embryo as to occasion 
monstrosity? Medical philosophers have never much delighted in acknow- 
ledging their ignorance of causes, and this question has consequently re- 
ceived very numerous and various responses. Original malformation of the 
germ, disease of the embryo, adhesions between it and its membranes, vio- 
lent accidents happening to the mother during the early months of gestation, 
sudden and intense emotion of her mind, long continued anxiety, unnatural 
connections with brutes, cacodemons, and evil genii; are among the causes 
which have been assigned by different authorities. Of explanations embra- 
cing such suppositions, some are evidently absurd, and have been long since 
exploded and despised; others are conjectural and disputable; and others 
again can be applied only partially and in particular cases. Mr. Lawrence 
ascribes the aberrations from the usual form and structure of the body to ir- 
regular operations of the powers concerned in generation, and places them, 
■with respect to their cause, on a level with unhealthy executions of the nu- 
tritive, secretory, and exhalent functions.* This view is unquestionably 
correct, but at the same time it is far too general to be satisfactory to the' 
restless and impatient spirit of curiosity. The ancient notions of monstrosity 
arising from supernatural agencies arc of course to be ranked among the 
ineptfe et fahulosae nugse of superstition, and there is no doubt that the 
causes which impress the embryo with deformity are as natural and physi- 
cal as those which communicate pleurisy or rheumatism to the adult. But 
while it is generally easy enough to ascertain the occasions of those and 
many other diseases, or rather the conditions under which they occur, such 
is far from being the case with regard to monstrosities; and if the Baconian 
maxim be correct that '* vere scire est per causas scire," I fear we shall 
have to confess, that respecting the true nature of a large proportion of 
anomalous formations we are as yet very profoundly ignorant. 

Cases in which the uterus is wanting are, as 1 have already said, not at 

* Medico-Chirurgical Transactions, vol. v. p. 165. 

Chew's Case of Absence of Uterus in an Adult Female, 45 

all numerous; but they are not altogether so rare as certain writers have sup- 
posed. M. Fournier, in the article " Cas Rares" of the Diclionnaire des 
Sciences Medicates, mentions an instance related by Lieutaud as the only 
one that appears on the records of medicine. " Les annales de la science 
medicale ne nous ofTrent qu'un seul exemple d'une femme privee de matrice, 
Le cas de cette singuliere observation est rapporte par Lieutaud. II n'y avait 
chez le sujet nul vestige, aucun annexe de la matrice: le vagin elait le seul 
qui existat; il se terminait superieurement en cul-de-sac: cette disposition 
faisait que la femme ne pouvait remplir le devoir du mariage sans eprouver 
une douleur qui rendait le commerce de son mari insupportable." 

Of this case, which as stated by Fournier is both in an anatomical and 
physiological point of view very incomplete and defective, it was not strictly 
correct to assert even in 1826 that it was the only one of its kind recorded, 
two at least having been noticed previously; and subsequendy to that date 
several others have been reported. 

Morgagni informs us, that Columbus, the distinguished anatomist of Cre- 
mona, dissected the body of a woman who was born without a uterus, and 
that a similar case had occurred to Fromondus, a celebrated fellow citi- 
zen of Columbus.* From two such instances having been met with in the 
same city, Morgagni infers that a proper examination would probably show 
that many other women present examples of the same deficiency, and that 
among those who have no menstrual effusion, absence of the uterus is much 
more frequent than has generally been suspected. 

This illustrious author appears, however, to have been somewhat too 
ready to admit the existence of such an accident of structure. He recounts 
two cases that fell under his own observation, in which he was satisfied of 
its presence not by an examination per rectum, but simply by the fact that 
neither of the women had ever menstruated, and that the vagina in one of 
them had no external orifice, and in the other terminated after extending 
only a third part of its usual length.t His conclusion may have been correct 
enough, but his reasons for adopting it are certainly far from being valid. 

A case in which the uterus was absent is related by Professor Cailliot, in 
the second volume of the Memoirs of the Medical Society of Paris. The 
patient had never menstruated, and yet enjoyed excellent health. She 
was deficient in none of the other characteristics of her sex, except that her 
breasts were small. A canal, between two and three lines in diameter, and 
about an inch in depth, occupied the place of the vagina, and terminated in a 
cul-de-sac. The most accurate examinations discovered nothing like a uterus. 
At the age of twenty-six or twenty-seven, this woman became subject to a 
pretty frequent evacuation of bloody urine, which recurred at irregular 
periods, and was perhaps intended to supply the place of the catamenia. 

* De Sedibus et Causis Morborum, Epist. 46, Art. 13, 
t Epist. 46. An. 11, 12. 

'46 Chew's Case of Ahsmu of Uterus in an Mult Female. 

The following instance occurred under the observation of Dupuytren, and 
is reported by Breschet. kg. Melassene, aged twenty-seven years, requested 
on the 24th of February, 1823, to be admitted into the Hotel Dieu, for a 
iistula in aiio. She stated that she had never menstruated; that at certain 
periods she felt a heaviness in the head, flushings and heat of the face, and 
pains in the abdomen; all of which symptoms were uniformly removed by 
the application of leeches to the anus. The external genital parts appeared 
well formed; the pelvis was perhaps rather narrow, but the breasts were 
fully developed, and all the appearances announced the most perfect femi- 
nine conformation. The finger introduced into the vagina, was arrested, at 
about the depth of an inch, by a smooth round cul-de-sac, above which 
nothing could be felt indicative of the presence of a uterus. The patient 
■was asked if she had ever felt any of the pleasures of love; she answered 
in the negative, but said that she had lived four years in a state of concu- 
binage, and was then on the point of marrying. She was operated on for 
the fistula on the 28th of February, and died on the 15th of March, of 
acute inflammation of the liver. Upon examination after death, the vagina, 
about an inch in length, was found to terminate abruptly; behind it lay the 
rectum, above and behind the bladder were found the broad ligaments of the 
uterus, which contained within their substance fallopian tubes and ovaries 
well developed. There was no uterus to be found, but at the point of union 
of the fallopian tubes was discovered a small body, which neither presented 
a cavity, nor had in other respects the least resemblance to a womb.* 

Dr. Macfarlane of Glasgow, relates the case of a woman who applied to 
liim to be operated on for a defect of her vagina. She was twenty-eight 
years of age, her external organs were well formed and entire, her mammas 
large, and she was not deficient in sexual feeling. The orifice of the. vagina 
was completely closed by a thick, firm muscular looking substance, continu- 
ous with the inner margin of the labia, and adhering to the pubes below and 
around the urethra, so as to leave not the least trace of an opening. The 
patient had been subject to severe attacks of epistaxis, since she was sixteen 
years old, to vertigo, flatulence, palpitations, pains in the lumbar region, 
Tomiting and occasional diarrhoea. An operation was performed by Dr. 
Macfarlane, in February, 1823, with a view of opening a passage to the 
womb. The patient died of peritonitis. Upon examination of her body, 
the ovaria were found large and well shaped, and the fallopian tubes were 
each an inch and a quarter in length, their fimbriated extremities being 
perfect. There was no vestige of a ut<3rus. In the normal situation of that 
organ, was a portion of condensed cellular substance, about the size of a 
■filbert, more than an inch distant from the uierine extremities of the tubes, 
and loosely attached to the periloneum.f 

* Repert. d'Anatomie Pathologique, tome v, p. 99. 

t Macfarlane's Clinical Reports of the Surgical Practice of the Royal Infirmary, Glas- 
gow, 1832. 

Chew's Case of Msence of Uterus in an Adult Female. 47 

Mr. Kingdon, in 1826, stated to the London Medical Society a case of 
absence of the uterus which had occurred in his practice, He had availed 
himself of the assistance of Mr. Lawrence, and although, they had both 
made a most careful examination of the parts, with the aid of Weiss' specu- 
lum vaginae, and had most cautiously investigated the case, no uterus could 
be detected. The vagina was about three inclies in length. The upper 
part appeared to lie in contact with the rectum, and beyond it nothing could 
be felt. This patient had the usual female figure; but the breasts, although 
of a moderate size, appeared to be so rather from a state of general embon- 
pointy than from a development of their glandular structure.* 

The anatomy of this case, if no means of exploration were resorted to 
save those which are mentioned, must be considered very dubious: respecting 
its physiology not a word is said. 

M. Renauldin presented to the Academy of Medicine the genital organs of 
a woman, in whom the uterus was wanting. This person died at the age 
of fifty-two y£ars; she was of very small size, had never menstruated, her 
breasts had never been developed, and her intellect was imperfect. The 
parts of generation externally were well formed, but a finger introduced into 
the vagina encountered, instead of the neck of the uterus, a small tubercle 
possessed of but little sensibility. Between the bladder and rectum, instead 
of a uterus, was a firm cord, about the size of a quill, communicating with 
the vagina, and also with the fallopian tubes. Some traces of ovaria were 
faintly perceptible. On slitting open the vagina and the cord-like canal above 
it, the first was found to be properly formed, and the last, which w^as only 
an inch in length, was evidently an imperfect neck of the uterus. The body 
and fundus of that organ were entirely deficient, t 

A case of absence or imperfect development of the uterus, was observed 
during the past year, in the Hopital de la Charite. Jeanne Fran^aise, ff)rty-six 
years of age, was admitted into that institution in January, 1839, under the 
care of M. Rayer. She had never suffered from any severe or dangerous 
illness, but had been for many years subject to distressing headaches, and 
frequent anomalous pains in the stomach, and throat. When fifteen years 
of age, she had experienced the symptoms wl^h usually announce the ap- 
proach of the menstrual secretion; but neither then nor at any subsequent 
period of her life, was there any appearance of uterine discharge. She had 
had occasionally a sanguineous flux from the bowels, and once or twice had 
been affected with vomiting of blood. During the last twelve months, she 
had suffered much from hysterical dispnoea, colic and diarrhcea, the stools 
being several times deeply tinged with blood. The mammae were well de- 
veloped, with the nipples projecting and surrounded by areolee. There was 
no hair in the axillae or on the pubes. The external organs of generation, 
and the vagina were perfectly natural; but on examining this canal with the 

* Lancet, vol. xi, p. 85. t Archives Generales, tome x, p. 474. 

48 Van Buren on the Immovable *Bpparatus, 

finger, no traces of cervix or os uteri could be discovered; it seemed to termi- 
nate in a cul-de-sac. At the extremity of the passage, a firm roundish sub- 
stance, of the size of a small walnut, could be felt through the lining mucous 
membrane: it was perceptible also by examination from the rectum. This 
was probably a rudimentary uterus. M. Rayer and Velpeau fully satisfied 
themselves of the accuracy of these statements. The woman was never 
married, but she had been cohabiting with a man, and appeared to have the 
ordinary sexual feelings.* 

The foregoing are the most remarkable and interesting cases of this kind 
that have been published. Others are recorded by Engel, Bousquet, Theden, 
Klintosch, Boyer, Meyer and Walther; several are referred to in Voigtet's 
Manual of Pathological Anatomy; and there are some, perhaps, reported by 
other writers which I have not seen, or cannot now recollect.! The instances 
which I have detailed are sufficiently numerous, and afford an ample de- 
monstration of the efl^ecls upon the female economy of this unusual depar- 
ture from the common arrangement of the system. 

Since the preceding pages were written, I have learned from a friend, that 
an instance of malformation, extremely similar to the one recounted in the 
beginning of tfiis paper, has very recently fallen under the observation of an 
eminent physician of Philadelphia. Whether this gentleman, who has 
obliged and benefited the medical public, by his valuable writings on more 
important subjects, designs to favor the profession with an account of this 
case, and with his opinions respecting it, I have not been informed. 

Art. IV. — On the Immovable Apparatus, and its therapeutic application 
to various Surgical diseases. By William Holme Van Buren, M. D. 

In the treatment of disease, perfect rest and quietude are among the most 
effectual means of ensuring its favourable termination: hence its importance 
in fevers, all internal inflammations, and nervous maladies. In many local 
affections its application is also indispensably necessary to effect a cure, and 
in others it forms a very valuable adjuvant. 

The possibility of rendering a diseased part of the body immovable, and 
the invention of an apparatus by which the physician may have it in his 
power to fulfil this important therapeutic indication with readiness and facil- 
ity, has always been a desideratum in medical practice. In general diseases 

* La Lancette Frangaise, Mars, 1839. 

t [Two cases have recently been recorded by Prof. Burggraeve of Gand. A notice of 
them, and of some others, will be found in the Summary of this Number, under the head 
of Anatomy and Physiology. — Ed.J 

Van Buren on the Immovable Apparatus, 49 

in which rest is requisite, the quietude attendant on confinement to bed, is 
mostly sufficient; therefore it is principally in local affections, that it becomes 
desirable to produce immobility by means of an apparatus. It is consequently 
indispensable to the perfect consolidation of all fractures; — to the retention 
of luxated joints in their natural position, after reduction has been effected; — 
it is necessary to the union of all solutions of continuity, and to the favorable 
termination of diseases of the joints, whether acute, or chronic. United 
with compression, and support of the part, it constitutes one of the most 
powerful resources which we possess in the treatment of articular effusions, 
and affections of the joints dependent on a scrofulous diathesis. — The expe- 
dient earliest adopted, and that in most general use at the present day for 
the purpose of procuring perfect rest of a part combined with compression 
and support, is the application of splints and bandages. The qualities neces- 
sary to be possessed by good splints, and the directions for their appli- 
cation have been detailed, and indefinitely varied by numerous surgical 
authors among whom none is higher authority than the celebrated Pott. 
Bandages have been in use from the earliest ages, and their application is 
now called for every day in surgical practice for the purposes of compres- 
sion, support and the dressings of ulcers and wounds whether caused by 
accident — or the results of surgical operations. These have been combined 
in a thousand different ways, and have served as the materials for numerous 
different kinds of apparatus, devised for the purpose of fulfilling the indi- 
cations offered by different cases. The object which the ingenuity of the 
surgeon and of the mechanic has thus endeavoured to attain in these various 
changes, is to obviate the bad qualities inherent in all machines composed 
entirely of splints and bandages, and to supply their deficiencies. The fol- 
lowing are some of these inconveniences: — the patient is long confined to 
his bed; he becomes extremely fatigued by the position which he is com- 
pelled to sustain; the digestive and other functions become impaired; and the 
general health frequently suffers to a great degree. To obviate these diffi- 
culties, machines have been invented; of these but one, that has come into 
use, answers at all the purpose for which it was intended; I refer to that of 
Amesbury, and its modifications. Besides the confinement and its conse- 
quences, there are many other objections to be urged against the use of ban- 
dages and splints, and their substitutes heretofore employed: — the complica- 
ted nature of most of these machines; — the want of facility, with which 
they may be obtained; — their weight, clumsiness, and the inconveniences 
to which the patient is subjected by their easy derangement; — the abrasion 
and consequent ulceration, to which parts are liable from their friction; — the 
necessity of their repeated renewal for the inspection of the part; or for the 
readjustment of the apparatus, which frequently becomes necessary from 
obvious causes. With regard to their efficacy in maintaining a state of 
immobility, we have the following decisive opinion of Boyer, than whom 
no one has ever had a better opportunity of judging: " Malgre I'opinion 
No. LI.— May, 1840. 5 

50 Van Buren on the Immovable »^pparatus. 

generalement adoptee, il est facile de demontrer, que les bandages ne ser- 
vant que tres peu, ou meme point, a maintenir les fragmens dans leur rapport 

The following remarks are however still more pertinent and from even 
higher authority than Boyer: " Nam neque in quiete, ut putant, crus conti- 
nent, neque dum reliquum corpus in hanc vel illam partem convertitur, canales 
prohibent quominus crus sequalur, nisi, homo ipse diligenter advertat."t 

Among the most useful machines which have been devised as substitutes 
for the bandages and splints, may be mentioned that of McTntyre, which is 
constructed so as to open and allow its removal, and at the same time when 
closed to remain accurately adjusted to the limb; — the jfj^paratus of Mr. 
Greenough for fractures of the lower extremities, attains the same end, and, 
in addition, entirely supports the limb in an iron frame work; the appa- 
ratus of Desault for fractures of the thigh, as modified by Physick and by 
Hartshorne, is now only rivalled in the generality of its employment by the 
inclined planes of Marsinna. To prevent motion of the patient's body, 
v/hich the common machines will not allow without derangement, Mr. Earle 
invented his very useful fracture bed, of which the French possess several 

These inventions, although the most ingenious of their kind, are still liable 
to many of the objections before mentioned; their complexity, expense, and 
limited application, still remain to prevent their general use. — Thus has the 
ingenuity of the profession ever been taxed for the perfection of this most 
important surgical apparatus; and this perfection has not as yet been attained, 
except in particular instances. The great desideratum — the object requisite 
to the accomplishment of all the indications presented to the physician in 
cases where perfect rest and immobility (combined or not, as it may be 
with compression and support) are necessary, has been the discovery of a 
substance with which a bandage may be impregnated, allowing its applica- 
tion with readiness and facility, and immediately afterwards becoming per- 
fectly firm and hard, so as to supply the place of splints, in the support of 
a part. 

It is not only of late years that the attention of the profession has been 
directed to this subject. We have evidence that the Arabians, and some of 
the Eastern nations, were in possession of an immovable apparatus, which 
they were in the habit of applying to the treatment of fractures. It is gene- 
rally believed that the idea was first suggested, in modern times, to M. 
Geoffroy, on the inspection of some ancient Egyption relics. M. Sedillot,| 
in the early part of the past year, exhibited before the Royal Academy of 
Medicine of Paris, an apparatus made use of by the Arabians for fracture of 
the fore-arm; it consisted of numerous divided splints, each but an inch 

* Dictionnaire des Sciences Medicales, tome xvi, p. 535. 

t Hippocrates, Dc Fracturis. 

t Archives Medicales, Paris, Fevrier. 1839. 

Van Buren on the Immovable Apparatus. 51 

wide made of cane; these were firmly attached to a sheepskin, by means of 
which they were applied to the arm. Of this the splint recommended by 
Benjamin Bell* is but a modification; it consists of a thin strip of wood 
glued on leather and afterwards split longitudinally so as to be rendered flex- 
ible. A splint consisting of strips of whalebone attached by linen after the 
manner of women's stays and formerly much used by the English surgeons, 
is also on the same principle. — This expecUent calls to mind the injunctions 
of Ambrose Pare, when suffering from a fractured leg to his friend, Richard 
Hubert who was attending him: " You must fortifie" said he, "the sides of 
my limb with junk made of tents or little sticks, and lined with linen cloth. "f 
Both Fabricus Hildanus, and Heister recommend leather stockings rendered 
inflexible by brass rods to be used in certain cases of fracture. The modern 
Greeks, according to the statement of M. De Bougueville,! have long been 
in the habit of using a consolidating mixture, in their treatment of fractures; 
gum mastic is said to form its principal ingredient. A similar, though essen- 
tially different expedient is adopted in Spain, Corsica and the Brazils, intro- 
duced most probably, at first, by the African Moors. 

The Italians have long made use of an immovable apparatus, which has 
been brought into notice by Assalini, in the modifications which he applied 
to it — consisting chiefly in the substitution of moistened paste-board for the 
original materials. The itinerant bone-setters of Switzerland, and the 
southern and western provinces of France, some of whom have become quite 
notorious on account of their success in the treatment of fractures, sprains 
&c., employ paste-board, and willow splints; and solidify their apparatus by 
means of resin, pitch, mastic and other varnishes. Guy de Chauliac, one 
of the earliest writers on surgery in France, speaks of a composition which 
he employed, consisting of slacked lime, with different gummy and resinous 
substances. Ambrose Fare also recommends at length the following 
"plaster to hold fast restored bones: — U. Thuris, mastich, aloes, boli armenii, 
ana §j; Aluminis roch, resinae pini siccee subtilissime pulv. ana »5iij; Farinae 
ijss; Alburn ovorum q. s. — make thereof a medicine, and let it be applied 
all around the leg."§ 

Among the English authors on surgical subjects, Cheselden,|j is the first 
who makes mention of our apparatus; in his " Anatomy" he speak* of a 
bone-setter of Leicester, who employed a mixture of wheat flour, with the 
whites of eggs, with which he smeared his bandages in order to render them 
solid; subsequendy he adds: — " 1 think there is no belter way than this to 
treat fractures,/or it maintains so perfectly the position of the limb,'^ 1J 

*• Bell's Surgery, Phil. Ed. 1814, Appendix, p. 15. 

t "The works of that famous chirurgeon Ambrose Pare" translated by Thomas 
Johnson, London, 1642. 

tVoyage dans la Grece, Paris, 1820. 

§ Op. citata p. 584. |I lUh Edition 1778, p. 38. Lond. 

IT In Gataker's translation of Le Bran's " Operative Surgery'''' with observations by 

5'2 Van Buren on the Immovable Jipparatus. 

Mr. Lawrence, the celebrated surgeon of London, in a lecture which I 
heard him deliver on this subject in January, (1839), ascribed the first em- 
ployment of whites of eggs and powdered chalk, as a solidifying mixture, to 
a namesake of his a Mr. Lawrence of Brighton, Eng. within a few years 
past; he recommended the practice very highly, and went through the pro- 
cess before his class of applying the apparatus. It has been in use for some 
months past at St. Barlholemew's Hospital. 

Mr. Alfred Smee has lately published in the Lond. Med. Gaz. an account 
of certain " moulding tablets for fractures" consisting of a composition of 
gum arable and whiting, interposed between two layers of coarse linen. 
These appear to possess very valuable qualities as splints, and are certainly- 
equal if not superior to those made of felt soaked in gum shellac, which on 
account of their being patented by the inventor, are placed to a certain degree 
beyond the reach of the profession.* 

Lecat, a French surgeon, in the year 1735, in an essay on the treatment of 
fractures, to which a prize was awarded by the Royal Academy of Paris, 
makes the following assertion: — "A simple fractiire when reduced, requires 
only to be maintained; and it need be examined but once before its consoli- 
dation, ofiener is unnecessary." In 1768, M. Moschati, acting on these 
principles, presented to the notice of the "Academy" several cases of fracture 
which he had treated successfully by means of an apparatus, consisting of 
compresses and bandages saturated with the whites of eggs. The idea was 
again neglected, until resumed by Baron Larrey, in his well known ap- 
paratus employed with so much success after the batde of Moskwa;t this 
consisted of cushions and compresses, retained by the 18 tailed bandage, and 
rendered immovable by saturation with a mixture consisting of spirits of 
camphor, acetate of lead in solution, and whites of eggs; the apparatus thus 
applied remained undisturbed until the consolidation of the bones. Of its 
efficacy, and advantages, especially in military surgery, Larrey speaks in the 
highest terms. 

The employment of plaster of paris, mingled with water and made to con- 
solidate around a limb in order to render it immovable, which is generally in 
Europe ascribed to the celebrated DiefTenbach who made a very extensive 
use of it, was originally derived from the Moors of Spain,:}: and first brought 

Cheselden p. 453, the latter surgeon recommends the same mixture for the cure of " con- 
torted or club feet;" he also gives a case in which he applied it to a fracture of the fore 
arm which happened to a gentleman while travelling'; he continued his journey, and at 
the end of forty days, the bandages were removed and the cure found perfect. At a much 
later period John Bell recommends the same materials to be used in similar circumstances- 
Vide "Principles of Surgery" p. 137 Amer. ed. N. Y. 1812. 

* For an account of the moulding tablets Sec Med. Exam. vol. ii, no. 14. from Lond. 
Med. Gaz. 

t Larrey's European Campaigns. 

X Eaton's Travels in Arabia. 

Van Buren on the Immovable Apparatus. 53 

into notice in Europe, by Prof. Kluge of Berlin, in 1829, and Drs. Muttray* 
and Ranch, who wrote theses upon the subject. Before this, however, as 
early as 1819, Prof. Gibson of the University of Pennsylvania, had devised 
this method of treating fractures, &c., and had explained the manner of its 
application to his class.t It has been frequently tried both in Europe, and 
this country, but there are several serious objections to its use of which the 
most prominent is the extreme fragility of the plaster, thus to a great extent 
limiting the motion of the patient. I saw several cases of club-foot, which 
had been operated upon by section of the different tendons, retained thus in 
a plaster mould, in the Middlesex Hospital at London, under the care of Mr. 

In the year 1834, M. Seutin, Professor of Operative Surgery in the Uni- 
versity of Brussels i and Surgeon of the " Hopital St. Pierre^'" of that city, 
having under his care many of those wounded at the siege of Antwerp, 
made a fair trial of the apparatus of plaster; but he found that the material 
lost in tenacity what it gained in solidity; and that it wr.s easily broken, thus 
losing its most important advantage, that of permitting progression and ex- 
ercise.:}: He then employed that of Larrey, which possessed neither of 
these disadvantages; but he found in it others, viz: — its weight, the difficulty 
of always procuring its ingredients, and the trouble required in its subsequent 
removal. M. Seutin was thus led to search for some other material which 
would combine the firmness and efficacy of those used by Dieffenbach, and 
Larrey, and, at the same time, be free from their inconveniences. The 
substance in which he thought to find a combination of these qualities was 
starch. This he tried in various ways, and finally succeeded in applying it 
in such a manner as to satisfy his most sanguine expectations. The fol- 
lowing is the manner of its application; take for example a simple fracture 
of the leg: the materials necessary are three or four ounces of starch, pre- 
viously boiled; four common rollers, six yards in length each; and sufficient 
binder's board for four splints. After applying compresses wet with any 
discutient liquid, such as spirits of camphor, or Goulard water, to the part, 
a dry roller is passed from the toes to the patella, or above it according to 
the situation of the fracture, so as to form what is commonly termed the 
reversed spiral bandage; another of equal size is then applied from above 
downwards; the splints, previously cut and moistened, are now moulded to 
the limb, and the whole covered with a coat of starch; another roller is 
applied over the splints from below upwards, this is smeared with another 
coat of starch, and finally the remaining roller completes the apparatus. It 
is mostly necessary to place some charpie, or cotton, on each side of the 

* Muttray. — De cruribus fractis gypso liquefacto curandis. Berlin, 1831. 

t Strange as it may seem two English surgeons — Messrs, Beaumont and Sweeting, 
were contending a year or two since, for the honor of having first used the plaster to cure 
fractures; the latter gentleman speaks in the highest terms of his success. 

I British and Foreign Med. Review, Oct. 1838, and this Journal for Feb. 1839, p. 481. 


54 Van Buren on the Immovable apparatus. 

ankle, in order to fill up the hollow caused by the starting out of the fendo 
Jlchillis. Assistants are required to support the limb in a state of extension 
during the application of the apparatus, and as the roller commences at the 
root of the toes, and a portion of the heel is also left uncovered, this is ef- 
fected without difficulty. The fact that the toes, and a part of the heel are 
not covered is important, as from these parts the surgeon may judge of the 
general state of the limb, without removing the apparatus for the purpose of 
inspection. Still greater firmness may be given to the bandage by additional 
rollers applied as already indicated, with alternate layers of starch; the time 
which must necessarily elapse before the whole becomes p'^rfectly dried, 
varies from thirty to ninety hours. In a report* of the trial of this appara- 
tus, and of the success which attended its use in the New York City Hos- 
pital by Dr. Gould and several other surgeons of* that place, its advantages 
over those in common use are enumerated as follows, viz: — 1. Its accurate 
adaptation to the limb; 2. Its lightness and strength; 3. Its cheapness, and 
the facility with which it is obtained under all circumstances; 4. Its easy 
application; 5. It causes no ulceration either from friction, or confinement 
to bed; 6. The freedom of motion which it allows; and it obviates, lastly, all 
necessity of repeated adjustment.! It is well known that the starched ban- 
dages have been tried in most of our hospitals, and their general superiority 
is mostly acknowledged; still like all its predecessors, it has its faults; these 
are, the length of time required before the bandages become firm, and the 
want of support to which the partis subjected until the drying takes place; 
this latter objection which is seriously urged by some, will be seen hereafter 
to be, in most cases without foundation.^ I have ascertained by experiment 
that a starched bandage of moderate thickness will not dry perfectly in less 
than 50 hours; by suspending the limb from a common cradle, or fracture 
bridge, after its application, by means of two or tliree small strips of bandage, 
paper being interposed to prevent their adhesion when dried, and by placing 

* New York Journal of Med. and Surg. July, 1839. 

t In the Maryland Medical and Surgical Journal, January, 1840, there are two cases 
described by Dr. A. F. Dulin which he treated successfully with the immovable appara- 
tus; in conclusion he observes: — " Hitherto the various objections adduced against tliis 
method of treatment have not from experience been found valid." 

There is also in the same number a description of a case of fracture of the thigh in an 
infant successfully treated in the same manner by Prof. Horatio G. Jameson of Baltimore. 
This application of the apparatus supplies a void in surgical practice which has hitherto 
been in a great degree neglected. 

% There have been several cases reported in the journals of late of unsuccessful results 
from the use of the starched bandage; one by Dr. Defer of Metz, (see this Journal for 
February, 1840, p. 460,) which was evidently caused by shameful neglect on the part of 
the surgeon who first applied it; and severil others in the last Number of this Journal, 
p. 461. In these cases the want of success must be referred to its proper cause, whether 
existing in the apparatus itself, or in the manner in which it is applied, which latter is 
the more proballj. 

Van Buren on the Immovable Apparatus. 55 

vessels containing hot water* on each side of the limb,t so as to create a cur- 
rent of heated air which may have free access to all parts of the apparatus, 
it may be perfectly dried in twenty or twenty four hours and frequently 
sooner. The difficulty experienced in quickly drying this apparatus, led me 
partially to investigate the subject, and in a series of experiments which I 
tried with this view I found the following results: 1. By boiling the starch in 
a solution of acetate of lead, e. g. §ij to the pint, or stronger, instead of 
using pure water, that the resulting compound was equally tenacious, if not 
more so than the starch prepared in the usual way, and that it became dry 
in much less time, generally from 15 to 20 hours, and frequently sooner. In 
this experiment a slight excess of diluted acetic acid was added to the solu- 
tion of the acetate of lead in order to prevent the formation of a subacetate 
of lead, on the volatilization of a portion of the original acetic acid by the 
boiling and the consequent decomposition which would occur, owing to the 
incompatibility of the subacetate with the starch. 2. By roasting a portion 
of dried starch for a short time at a heat of about 230° Fahrenheit, so as to 
very slightly discolor it, it was rendered soluble in cold water, as originally 
demonstrated by Caventou, this solution dried on a bandage much sooner than 
the ordinary one, but when dry it was much less tenacious, more fragile, 
scaly and brittle, this in fact appears to be identical with the substance wliich 
De Saussure originally denominated " amyline.''^i A solution of starch 
exposed to a temperature of 70° Fahrenheit, undergoes fermentation, and is 
resolved partially into its several proximate principles, among which are 
sugar, the above mentioned " «mi//i?ie," and a gummy substance called 
" dextrine'^ of which I shall hereafter speak; to this probably its dried so- 
lution owes its firmness. 

After the publication of the report of M. Seutin, in 1834, the first notice, 
as before mentioned which appeared on the subject, his system of treatment 
was tried by many of the surgeons of France and Belgium. Many modi- 
fications of different parts of the apparatus were attempted; — for instance 
that of M. Laugier, of Paris, who employs common stout wrapping paper 
cut in the form of the eighteen tailed bandage in place of cotton, or linen 
rollers; — of M. Lafarge de St. Emilion, who used a mixture of boiled starch 
with powdered plaster of Paris4 in place of the simple substance, and 
asserts its superiority; — the substitution of tin, zinc, leaden, and carved 
wooden splints for those of paste-board, &;c. &c. Still the original mode 
of its application is generally empl yed. 

* In the hospitals of Paris these vessels are commonly made of pewter or brass of a 
flattened spheroidal form, with an aperture on the top closed by a screw containing a ring 
by which they may be carried; this simple arrangement is frequently very useful in cases 
where it is necessary to sustain the temperature of a part by artificial means. 

t Annales de Chimie et de Phys. vol. xl, p. 193. 

X According to the experiments of Mr. Alfred Smee, a mixture of plaster of Paris and 
white of eggs possesses no tenacity whatever, and crumbles into powder when dry, spon- 
taneously. Op. cit. 

56 Van Buren on the Immovable .Apparatus, 

Among the surgeons of Paris, who gave to the improvement of M. Seutin, 
the fullest and fairest trial, the celebrated Velpeau stands first. He was 
earlj convinced of its superiorit}', and employed it in numerous instances 
which were highly successful. So fully convinced was he that the great 
desideratum to be attained in the treatment of fractures, was as it were 
within his grasp, in the possession of an apparatus so near to perfection, 
that he devoted all his resources to the search for a remedy for its deficiencies. 
He instituted an inquiry amongst the chemists of the metropolis for a sub- 
stance which could be substituted for the starch, and its faults, and in the 
course of this inquiry, he became acquainted with the results of the researches 
of M. Payen and M. Persoz, with regard to the chemical relations of fecula. 
The experiments of these gentlemen demonstrated that, by the action of the 
substance called *' diastase" existing in all farinaceous plants, as a proximate 
principle, upon fecula, (which action takes place in the process of brewing 
malt liquors, where both these principles are present in the malt,) there 
results the separation of an entirely new substance from the fecula, to which 
they gave the name of " dextrine."* From the properties said to be 
possessed by this dextrine, M. Velpeau thought proper to give it a trial; and 
the result of his experiment entirely fulfilled his anticipations; he found it to 
be precisely the substance which he required, and has since constantly 
employed it with increasing success in the immense field of practice which 
he enjoys, and the results of his experience are generally known to the pro- 
fession. It is here necessary that I should give a description of the " dex- 
trine," and of the manner of its application. 

" /)ex/nne" so called from the peculiar influence which it exerts in the 
polarization of light, turning the refracted rays to the right more than any 
other substance known, is generally met with in the form of a yellowish 
white powder resembling the " lycopodium," though not possessing its 
color; its taste and odour are very much like those of the seeds of the com- 
mon canteleup, or cucumber;! it is soluble to any extent in water either cold 
or warm; this solutionis viscid, tenacious and translucent, and on the evapo- 

* The peculiar action of the "diastase," in this case of chemical decomposition 
depends upon what Berzelius terms the "doctrine of presence." Its presence merely 
determines the elimination of the dextrine fi-ora the fecula by the process called "diasta- 
sis'" (from hcta-Tal^v to separate, which is merely a new name for a process which we can 
not comprehend,) hence the name of the substance " diastase." This property of " dias- 
tasis" is anologous to that possessed by certain substances to determine, by their "pre- 
sence" alone, in a solution, a combination between other substances which would not 
otherwise unite, itself at the same time remaining unaltered; this property of causing 
combination is called by the distinguished chemist cited above — the property of "cataly- 
sis." Fes an interesting paper by Dr. Draper, " On the Action of Presence," in the No. 
of this Journal for Nov. 1837, p. 122. 

t This resemblance is remarkably perfect, and it renders the supposition probable that 
the dextrine may exist in the melon family as a proximate principle in a distinct state; I 
I have not before seen this resemblance remarked. 

Van Buren on the Immovable Apparatus. . 57 

ration of the water, it is converted into a sort of varnish resembling glue, 
which is extremely firm, tough and unyielding, but is readily redissolved on 
the application of water. It is insoluble in alcohol. In powder it has to a 
considerable degree the feel of starch between the fingers, and when a por- 
tion is thrown on burning coals, or the flame of a lamp, it flashes more 
vividly than most other minutely divided combustible substances of a like 
nature. — According to Mr. Proctor when tested with the tincture of iodine 
it yields a vinous red or purple hue, difl^ering essentially from that produced 
in a solution of starch by the same test, and thus disproving its identity with 
that substance.* 

Dextrine has been used to a considerable extent in commerce and manu- 
factures, especially in Paris, and other parts of France, in the form of its 
watery solution with sugar, under the name of " Sirop de Dextrine," as a 
substitute for some simple syrups, and in the sophistication of others; it is 
also an ingredient in the French beer, as manufactured at Paris. The con- 
tinued action of diluted sulphuric acid upon starch, at the boiling point, 
results in the production of this substance; by carrying the process still 
farther the whole amount of starch employed is converted into uncrystaliz- 
able sugar. It thus appears that " dextrine" is one of the proximate organic 
principles, entering into the composition of all amylaceous vegetables and 
plants, in combination with fecula, amidine, diastase, gum, &c., &;c., analo- 
gous in its properties with many of them, but essentially diflfering from 
all; — that it exists wherever farinaceous plants are found, and may be obtained 
in a separate state with facility, and at little expense. It is sold in Paris, by 
the quantity, at the price of eight sous the pound. With regard to its 
practical application, the following is the manner in which M. Velpeau 
employs it. 

For a fracture of the tibia, about ^iv of the powder of dextrine are neces- 
sary; this is thoroughly moistened with spirits of camphor, which prevents 
it from caking when the water is added — as the powder is insoluble in alco- 
hol and its particles are merely separated, so as to be equally acted upon by 
the water. The quantity of water should be sufficient to render the solution 
about the consistence of molasses. If properly prepared, and allowed to 
stand a few minutes before use, it forms a sirupy solution fit for immediate 

In applying the apparatus to the leg, after reducing the fracture, a dry 
roller ,is passed from the toes to the knee; two splints cut from the common 

* Most writers on Organic Chemistry pass this substance without notice; Orfila in the 
3d vol. of the "Chimie Medicale," gives a limited description of its chemical relations. 
p. 386. 

It gives me pleasure to be able to refer for a more minute detail with regard to the 
" Dextrine", its mode of preparation &c., to an excellent paper entitled " Observations on 
Dextrine and Diastase" published in the Am. Journ. of Pharmacy— January, 1840, by 
Wm. Proctor, Jr. of this city. 

58 Van Buren on the Immovable apparatus. 

binder's board, and previously moistened so as to mould themselves exactly 
to the inequalities of the limb, are then placed one on either side; these are 
smeared over with the mixture, and a second roller, thoroughly soaked in 
the solution, is applied over them, and afterwards perfectly covered exter- 
nally by a coat of the varnish.* The limb would then, in the case before us, 
be suspended from a fracture bridge, and surrounded by vessels of hot water, 
in the same manner as previously mentioned in the description of the 
starched bandage. 

In this way the bandages in less than six hours, become so firm and 
hard as to sustain the limb more perfectly than the most complicated machines, 
and the patient may take exercise constantly, making use of crutches, and 
supporting the part by a stirrup of bandage passed around the neck, without 
the least danger of deranging tlie apparatus. In fact, patients at La Charite, 
with simple fracture, are frequently seen promenading the garden, in a day 
or two from their entrance, with perfect ease. When the period has elapsed 
which is necessary to the consolidation of the fracture, the apparatus is re- 
moved with the greatest facility, after soaking the part for a few minutes in 
water. In the use of dextrine in this manner, M. Velpeau has been grati- 
fied with the most perfect success. During a period of eight months of 
constant attendance in his wards, in which time upwards of fifty cases of 
fracture came under his care, I saw there no other apparatus but that of dex- 
trine — and the bandage of Scultetus for immediate use in compound fractures. 
Part of the time I was actively engaged in his service, and had frequent op- 
portunities of applying the apparatus under his inspection, and of closely 
watching its action during the whole progress of cure. Of its application to 
each particular case of fracture, luxation, &c., it would be useless to enter 
into a detailed description; the account which has already been given, will 
serve as a model for any that may occur. In any case where additional 
strength is required, the number of bandages of course must be increased. 

In fractures of tiie lower extremities where extension and counter-extension 
become necessary, this is effected, as usual, by a bandage around the foot 
and ankle before the dextrine is applied, made fast to the foot of the bed, and 
the common strap beneath the perinasum, attached above. In luxations, 
the common bandage is merely soaked with the solution of dextrine, before 
its application. In sprains, or luxations, accompanied by severe straining, or 
laceration of the ligaments, this apparatus is particularly valuable, as it secures 
such perfect rest and immobility, which are indispensable to a favorable ter- 
mination of the accident.! After the operation of tenotomy, or the cutting 

* A strip of stout binder's board soaked in a solution of dextrine, and dried, makes a 
very firm splint, and when moistened is easily adapted to any part of the body, where it 
may be retained by a simple bandage, — thus constituting a very simple and effectual 

t In fractures of the clavicle, and luxations of the humerus, M. Velpeau employs a 

Van Buren on the Immovable Apparatus. 59 

of the tendons for the cure of club-foot, there is no machine so generally use- 
ful, or so easy of access as the immovable apparatus. M. Velpeau employed 
it with the most perfect success in five cases, on which he operated whilst I 
was in his service; in one of these cases there were five tendons divided, and 
subsequently two more. It was also his very common practice to order its 
application to diseased joints, particularly in those cases where there exists 
a fungous state of the synovial membrane, which is so common a variety of 
the white-swelling, and in which, after the failure of the usual antiphlogistic 
treatment, perfect rest conjoined with compression is the only effectual re- 
source. In articular efi'usions, especially of a chronic character, where im- 
mobility, united with pressure, is so useful in promoting absorption; in cox- 
algia, and the different varieties of diseased joints requiring rest and support, 
the immovable apparatus has been employed with very favorable results. In 
the '^phlegmasia alba dolens'*'' it has occurred to me that a regularly applied 
pressure to the whole limb, by means of this, or the simple bandage, united 
with the elevated position, would form a very good means of subduing this 
disease, which is by no means under the control of our art. I have had how- 
ever the opportunity of applying this treatment but to one case. In this in- 
stance the limb was excessively painful, the slightest motion causing the 
patient to cry out with the suffering; the dextrine bandage was applied in the 
evening, and the limb elevated; this was the fourth day of the disease. On 
the next morning the cedematous eff'usion had considerably decreased, the 
patient suff'ered no more pain, and the recovery advanced with unusual rapi- 

In the treatment of varicose veins, for the cure of which the opcation of 
excision, and the obliteration of the vein by means of pins, and ligatures, 
have proved, at best, such dangerous remedies, the immovable bandage offers 

peculiar bandage of his own; vsrhich is well known — this however is objectionable as it 
always brings the elbow forward, whatever may be the situation of the fracture, or the 
relation of the broken extremities; this he applies after merely soaking the roller in 
dextrine dissolved. 

* In the " London Medical Gazette" of June last, is published a clinical lecture deli- 
vered at the Westminster Hospital by Dr. Burns, in which he maintains that this dis- 
ease consists in a phlebitis of the leg caused by the pressure of the pregnant uterus 
upon the common ihac veins; and that the left leg is more commonly affected than the 
right, owing to the fact that the left iliac vein when it reposes on the last lumbar vertebra 
is crossed by the common iliac artery, and is thus subjected to a double pressure, the 
arrangement not being the same on the right side. He confirms this idea by the citation 
of 20 cases described by Linn, Davis and Velpeau, in which number the right leg was 
affected in one case, both legs in 6, and in the remaining 13 the left alone. This explana- 
tion is rendered plausible when we remember that the "noise of the placenta," as it was 
formerly called, the "bruit placentaire" of Bouillaud, is ascribed by him to the pressure 
of the uterus upon the hypogastric arteries, and that this fact is now generally admitted 
by physiologists: If these ideas are correct, the pathology of the disease would indicate 
a treatment similar to that mentioned above, consisting of pressure and elevation of the 

60 Van Buren on the Immovable Apparatus, 

a valuable substitute for the laced stocking, &c., at least in hospital prac- 

Having now mentioned all the peculiarities of the improvement of M. 
Velpeau, the ensuing remarks will apply equally to the starched apparatus, 
and that of dextrine,* for it will be perceived that the one is but an improve- 
ment on the other, and that many advantages are possessed in common by 

With regard to the application of this apparatus to the treatment of com- 
pound, and comminuted fractures, I have not as yet spoken. By surgeons 
of high authority who have given to it a fair trial, contradictory opinions have 
been expressed. The common practice of M. Velpeau is to apply at first 
the bandage of Sculletus, and to continue this until the external wound is in 
a favorable state for healing, when the dextrine is applied without delay; 
while the bandages are still wet, a hole is cut out immediately over the 
woundf so as to allow free access to it, and it is dressed daily. Of late M. 
Velpeau has been gradually growing more partial to the immediate applica- 
tion of the dextrine, in despite of the inflammation and tumefaction of the 
part, and he does not hesitate to defend this practice in public, in which he 
is sustained by Larrey, Gimelle, and some others.l: 

* It may be proper to remark that M. Velpeau objects to the term " appareil inamo- 
vible," (immovable apparatus,) which is generally applied to this bandage; Larrey, how- 
ever, whom the French consider as its original inventor, approves of the term, as also 
does Seutin. I have used the phrase indifFerently as it will be perceived, applying it 
both to the dextrine and the starch. 

t This expedient was resorted toby Dieffenbach in his plaster apparatus, and according 
to M. Sedillot was also employed by the Arabs in their immovable splints consisting of 
split reeds and sheepskin. — Gazette Medicals. 

t In order that there may be no misunderstanding on this point, I will quote the words 
of Velpeau, in some remarks which he made at the Academic Royal de Medecine, on the 
sitting of August 5th, 1839; published in the Gazette Medicale of August 10th 1839.— 
" Je me suis beaucoup occnp6 du traitement des fractures; j'ai traite un grand nombre 
.de malades depuis Tcpoque ou j'ai commence k en faire I'application, puisque je pour- 
rais citer maintenant plus de 150 observations; j'ai done quelques resultats interessans 
&, presenter a I'Academie. Je ne crois pas qu'il y a de danger dans I'application immediate 
du bandage inamovible; s'il n'y a pas d'engorgement, ce moyen en previendra le develop- 
pemeni; s'il y a deja de la tumefaction, et que la compression soit bien faite, elle desparaitra; 
rien n'empeche d'enlever I'appareil dans le cas od il produirait de la douleur, ou pourrait 
amener des accidens. ***** Dans les faits qui se sont passes sous mes yeux, la 
compression qu'il exerce m'a paru toujours fort avantageuse pour dissiper la tumefaction; 
il a passe rarement a I'etat de suppuration. ***** Je n'ai pas vu une seul fois dans 
le nombre des faits que j'ai observes, survenir des accidens qui, avec quelque raison, puissent 
etre attribues au bandage. * * * * 

" S'il doit etre enleve, et renouvele, on le ramollit en I'humectant; rien n'est plus facile." 
L'appareil de dextrine durcit avec une grande rapidite; il suffit de quelques heures, au 
lieu de trois jours qu' exigeait le bandage de M. Seutin. * * J'ajouterai qu'il est facile, en 
surveillant attentivement le developpement des douleurs, en consultant la teinte du mem- 
bre, I'apparition de phlyctenes, «Stc., de savoirau juste quand il faut d'enlever l'appareil." 

Van Buren on tlte Immovable Apparatus. 61 

The application of compression by bandaging, as a direct means of subdu- 
ing imflammation, has been strongly advocated in this country, by Prof. 
Dudley, of Kentucky, and his experience coincides with that of Velpeau.* 

Thus Suetin and Velpeau, who have had the greatest experience on the 
subject, agree in applying the bandages immediately; they are supported by 
Larrey, Gimelle and Berard, who cite thirty cases treated in this manner. 
On the other hand MM. Blandin, Breschet, Gerdy, and some others differ 
on this point, but their experience is more limited. There exists also a dif- 
ference of opinion with regard to allowing the patient to take exercise; 
Suetin, and his partizans above cited, recommend exercise on crutches, with 
the limb supported wholly, or partially, by a stirrup from the neck; Blandin, 
Breschet, Amussat, and some others object to this practice, considering 
that it favours the formation of false articulations. All concur, however, 
in recommending the plan of making openings in the bandages opposite 
to external wounds, an expedient which it appears was adopted by the 
ancients, as it is explained, and figured in the work of Scultelus, and 
noticed in other authors. 

It now remains for me but to discuss the objections, which have been 
urged against the employment of the " immovable apparatus," and to enu- 
merate the advantages which it possesses, whether composed of starch or 
dextrine, over those commonly in use. It has been objected to the apparatus 
of starched bandages, that the limb to which it is applied is destitute of sup- 
port until the bandages are dry, which requires from 30 to 96 hours. But" 
it is not within the first two or three days, that displacement of the fractured 
extremities is tobe feared; at a later period, when some degree of motion is 
allowed, there may be danger of its occurrence. The starched bandage 
while still wet is very nearly as firm as the ordinary apparatus, and if there be 
any fear of trusting to it alone, the expedient of Amussat may be resorted to, 
viz: — the application of a wooden, or metallic splint to the outside of the 
bandage until it is dried. This objection, however, cannot be urged against 
the dextrine, as it can be dried in three or four hours. Again it is said that 
when applied upon a tumefied limb, the swelling when it subsides may leave 
the bandage too large; when this takes place to a considerable degree the 
apparatus must be renewed; than this nothing is easier to eff*ect, as the same 
bandages may be reapplied; when the disproportion is inconsiderable it may 
be remedied by stuffing charpie, or carded cotton into the crevices of the 

In a case of fracture of the tibia and fibula, treated successfully by the 
starched bandage at the Pennsylvania Hospital, by Dr. Thos. Harris, this 
inconvenience was satisfactorily remedied, by applying a bandage over the 
.apparatus at an advanced period of the cure, which by compression, ohlitera- 

* Vide "Transylvania Journal of Medicine." vol. i, No. 9, November, 1828. 
No. LI.— May, 1840. 6 

62 Van Buren on the Immovable Apparatus. 

ted the disproportion between it, and the limb, which had become somewhat 
shrunken from atrophy of the muscles.* 

Prs. Christophers and King, in several instances in which they wsed 
Seutin's bandage, successfully adopted the expedient of slitting it down in 
several places, and surrounding it by two or three gum elastic straps.t 
Some have expressed great fears that the compression thus effected by ap- 
plying a firm bandage to a swelled limb, would cause strangulation, and sub- 
sequent gangrene; but these fears are unfounded, as daily practice proves to 
the contrary; in fact we do not strangulate the limb in thus applying the ap- 
paratus; compression is effected with regularity from below, upwards, and 
experience shows, that far from inducing injurious consequences, it produces 
the most beneficial results.^ Compression regularly applied to a healthy 
limb would produce atrophy, not gangrene; and on a swelled and inflamed 
part it reduces the inflammation, and if we are to credit the results of Vel- 
peau's experiments, it produces effects almost like those of enchantment. 
He commenced its use with the same ungrounded fears of strangulation and 
all its consequences; but the results of reiterated experiments dispelled his 
doubts, and confirmed him in that practice which he now so strenuously 

Another disadvantage attributed to this method, is that we are left in the 
dark so entirely as to the state of the limb, that we can no tascertain whether 
there exist eschars, abscess, or any other complications. Now if only mode- 
rate attention be employed, none of the accidents need occur; they must 
produce pain, and general symptoms, and then the bandage maybe removed: 
a.s regards strangulation too, the extremities of the toes and the heel remain- 
ing uncovered, give timely notice of the approach of gangrene. | With regard 
to the confinement of pus, by the application of the bandage to cases com- 
plicated with wounds of the integuments, experience has proved that it does 
not give rise to those pernicious results too generally apprehended; the pus 
is not decomposed by the contact of the air, and infiltration of the integu- 
ments rarely takes place. — The formation of psuedo-arthroses, or false articu- 
lations, an objection so much dwelt upon by the opposers of this plan of 
treatment, is ever the result of carelessness, and want of judgment on the 
part of the practitioner, or of other obvious causes, and the immovable ban- 
dage is no more liable to induce such consequences than is any other appa- 
ratus inefficiently applied. At all events these objections can not be urged 
against its employment in luxations, sprains, club-foot, diseases of the joints 
&c., &;c. 

* Med. Exam. vol. ii. No. 9, where there are reported five other cases treated with 
success, by the same surgeon at the Pennsylvania Hospital, after the method of Seutin; — 
three of these were oblique fractures of the femur which were cured without perceptible 
deformity. In all these cases more or less exercise was allowed during the cure. 

t London Med. Gaz. Aug. 11th, 1839. 

\ Brit, and For. Med. Review, Oct. 1838, and this Journal for Feb. 1839, p. 483. 

Van Buren on the Immovable dpparatus^ 6tl 

But by far the most powerful arguments which can be brought forward 
in support of this method of practice, are the undoubted results of experience. 
Seutin with his 200 cases, and his distinguished success, has passed with 
triumph the critical ordeal, and severe scrutiny of the French surgeons, ever 
so distrustful of foreign improvements, and modern innovations, and has 
succeeded in convincing them of the efficacy of his treatment, and in sub- 
stituting it to a great extent for their own. Larrey, Velpeau and Blandin, 
the committee of the Royal Academy of Medicine of Paris, the authority 
of the French capital, and the arbiters of surgical practice, after a patient 
investigation of the subject, report in the most favourable and even enthusi- 
astic terms their conviction of its superiority, and each adds his personal 
testimony as additional tribute.* 

In addition we have the testimony of the cautious Breschet, of Amussat, Bc- 
rard, Rochoux, Gimelle, Emery, Laugier and Lafargue, who have each tried 
thoroughly the experiment, and unite in confirming its success. The anticipa- 
tions of Cheselden have been realized; and the approval of Lawrence has 
been more than confirmed. — The British and Foreign Medical Reviewt in 
the early part of the present year, contained a review of some length, in 
which the subject is discussed at large, and the employment of the immo- 
vable apparatus meets with the most hearty approval; the objections to its use 
are ably refuted, and its superiority fully asserted; the learned reviewer in 
conclusion remarks: " To those persons who are unconvinced by our state- 
ments, we would say, make the experiment yourselves; make it fairly and 
without prejudice; and do not pronounce judgment without having experi- 
mentally tested its correctness." 

In so limited an essay as the nature of the present paper requires that it 
should be, we can but glance at the immense advantages which must accrue 
to the physician, as well as to the patient, on the introduction of the immo- 
vable apparatus into general use, in its convenience and economy in military 
and naval surgery, in hospital practice at large, and amongst the poor; — to 
the traveller whom an accident can na longer delay in the prosecution of 
his journey; — to the tradesman who in many cases may continue his occu- 
pation, if a sedentary one, with a fractured limb. There are no painful 
excoriations, nor tedious ulcerations to torment the bed-ridden patient in his 
monotonous and wearisome confinement; — to irritate the constitution, and 
drag down the health, which is so often, and so severely affected. 

In the public practice of M. Seutin, it is reported that on each occasion 
the bandage has been promptly applied, and the patient has been in the 
greater number of cases, raised up and placed on crutches as soon as the 
bandages were thoroughly dried. Persons have proceeded on their jour- 
neys at the end of three days from the application of the apparatus. Those 

* For their Report and several opinions, see Gaz. Medicale de Paris of August 10th 
t In a critique upon the works of Burke and Lonsdale on Fractures, Feb. 1839, 

. aii'^Hk ^.uM*. 

64 Hayward's Statistics of imputations, 

living in town, with simple fracture, are bandaged, looked after for four or five 
days, and then discharged; at the end of five or six weeks they come again 
to the hospital; the apparatus is removed, and they are found cured, and 
ready to return to their usual occupations. 

In conclusion I can do no better, than repeat the words of Velpeau, to 
whose enterprise and industry the profession is already so largely indebted: 
"Ce qui m'etonne, c'est que ce bandage ne soit pas plus generalise encore 
dans son emploi; il est si simple, si facile, et presente tant d'avantages, et 
si pen d'inconveniens, que je ne comprend pas les reproches qu'on pourrait 
lui addresser." 

Art. V. Statistics of the Amputations of Large Limbs that have been per- 
formed at the Massachusetts General Hospital; with Remarks. By Geo. 
Hayward, M. D., one of the Surgeons to the Hospital. 

The following table, it is believed, contains a list of all the amputations of 
large limbs that have been performed at the Massachusetts General Hospital 
since the establishment of that institution. Such particulars are added as 
were thought calculated to throw light on the subject. These in a few in- 
stances are not so full perhaps as could be wished. 

This remark applies especially to some of the early cases, which occurred 
at a period when the records of the hospital were not kept with that pre- 
cision that has since been adopted. The omissions, however, are not 
thought to be such as will impair to any extent the value of the table. 

The statistics of amputation are very desirable. They may probably 
lead to practical results of some importance. From what has recently been 
published, it is evident that amputation is more often followed by the death 
of the patient, than was formerly supposed. But to what extent this can be 
attributed to the operation itself, or to the disease or injury for which it was 
performed, cannot be precisely determined. 

It has been stated, that more than one-half of all whose limbs are ampu- 
tated at some of the hospitals of Paris, die; and it appears, from a very valu- 
able paper published by Dr. Norris in the Number of this Journal for August, 
1838, that of fifty-five patients, being the whole number on whom amputa- 
tion was performed in the Pennsylvania Hospital during a period of eight 
years, twenty-one died. 

And yet, these unfavorable results cannot fairly be attributed to the opera- 
tion alone. There are a variety of causes that would exert a bad influence 
in the hospitals of Paris, that are not to be met with in those of our country. 
The former are more crowded, less comfortable, and badly ventilated in 

Hay ward's Statistics of Jlmputations. 65 

comparison with similar institutions here, and it is believed that the after- 
treatment is not so faithful and assiduous as with us. 

Dr. Norris, has no doubt suggested the true cause of the large proportion 
of fatal cases in the Pennsylvania Hospital, and that is that the operation 
was probably in many cases too long delayed, in the hope of saving the 
limb. No one can doubt, who knows any thing of that institution, that 
nothing would be omitted that would be thought likely to add to the com- 
fort and safety of the patient. 

While it is no doubt true that amputation is sometimes too long delayed, 
it is equally certain that it is often performed when it might have been 
avoided. It is difficult in many cases to decide on the best course, but the 
operation should not be done without the clearest evidence of its necessity, 
for it is a hazardous and painful one, and, even when perfectly successful, 
leaves the patient in a mutilated state. 

It will be seen by the subjoined table, that the results at the Massachusetts 
Hospital were somewhat more favourable than those at the Paris, and Penn- 
sylvania Hospitals above referred to. In a large proportion of the following 
cases, the amputation was done by the circular incision; the flap operation 
was adopted occasionally, whenever there was reason to believe that abetter 
stump could be made by it than by the other method. The dressings were 
always of a light and simple kind; consisting of two or three strips of adhesive 
plaster and a small compress and roller; and yet there are some surgeons of 
the present day, who would perhaps regard these as more cumbersome than 
was necessary. 

If the bleeding was slight, the dressings were applied before the patient 
left the operating room; but if diere was any thing more than an oozing from 
the veins, it was deferred till a few hours after. 

Secondary hemorrhage was not frequent, though it sometimes occurred; 
pressure was generally sufficient to arrest it, but occasionally it was found 
necessary to open the stump, and tie one or more vessels. In one case 
where hemorrhage occurred twelve days after the operation, from a diseased 
stale of the posterior tibial artery, the femoral artery was tied. No one 
who had secondary hemorrhage died, and though it sometimes debilitated 
the patient, in no case was there any permanendy injurious effect from it. • 

In all the cases it was attempted to heal the wound by the first intention, 
and in a few instances it was completely successful, but in by far the greater 
number it was only partially so. 

It has not been the usual practice at the Massachusetts Hospital to ad- 
minister an opiate before an operation, though in a few instances it has been 
done. In one case where amputation was performed on a patient with deli- 
rium tremens, twelve grains of opium were given shordy before the opera- 
tion; he became drowsy soon after and recovered. 



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Hay ward's Statistics of ^imputations. 69 

Tt was not thought necessary to indicate the exact part of the limb at 
which each operation was done, but it was supposed to be enough to say 
whether it was above or below the knee. It may be proper to add, that in 
all the cases below the knee, it is to be understood that the amputation was 
performed above the ankle. 

From this table, it appears tliat there were seventy operations on sixty-seven 
patients; three patients having two limbs removed. In one of these three 
cases, one operation was above and the other below the knee, and in the 
other two, both operations were below; the first patient died, and the other 
two did well. 

Of the whole number operated on, fifteen died and the remainder reco- 
vered, at least so far as to be able to leave the hospital; though it is probable 
that in some instances the disease may have returned. 

There were thirty-four patients who had the thigh amputated, and one of 
these had the other leg taken off at the same time below the knee; of this 
number, nine died. Of twenty-three patients whose legs were amputated 
below the knee, two having both legs removed, five died; and of the ten 
who had an arm amputated, six below and four above the elbow, one died. 

This goes to confirm the prevailing opinion among surgeons, that amputa- 
tion of the lower extremities is more often followed by fatal consequences 
than that of the upper, and that death takes place more frequently after am- 
putation of the thigh, than after that of the leg. More than a quarter of 
those whose thighs were amputated died, while there was but little more 
than one death in five among those whose legs were removed below the 
knee, and only one of the ten whose arms were amputated. This patient 
too died of delirium tremens. The operation to be sure did not arrest the 
disease, but apparently contributed nothing to the fatal result. 

This table tends also to support the opinion, that patients who undergo 
amputation for chronic diseases are much more likely to recover than those 
in whom it is performed in consequence of recent accidents. Of the first 
class, there were forty-five patients afflicted with various diseases, and of 
this number all recovered but six; and of the remaining twenty-two, whose 
limbs were removed on account of recent injuries, no less than ten died; 
being nearly half of the latter and less than one in seven in the former. 

This fact certainly gives support to the opinion, that a state of high health 
is not favourable to surgical operations; and it also tends to show that death 
after amputation is not by any means attributable in all cases to the operation 
alone; for if it were, the proportion of deaths should be as large among one 
class of patients as among the other. There can be no doubt, I think, that 
the result is influenced very much not only by the age and constitution of 
the patient and the disease or injury for which the operation is performed, 
but also by the period at which it is done. I have before said that I thought 
that amputation was "often performed when it might have been avoided." 
But this remark applies principally to cases of recent injury. In those of 

70 Hay ward's Statistics of imputations. 

chronic diseases of the limbs, the error is more apt to be of the opposite 
character; the operation is either not performed, or if done at all, frequently 
not till it is too late. It cannot be denied, I think, that there is a diposition 
at the present day to defer amputation too long in cases of diseased limbs; 
there is an unwillingness to admit that the morbid affection is beyond the 
reach of remedies, and the operation is too often postponed till other parts 
become affected, or the system is worn down by continued irritation. At 
length the limb is removed; but the patient, already exhausted by disease 
and long suffering, is hurried to his end by the very means that might have 
saved him, 'if they had been earlier employed. 

If amputation is frequently too long delayed in chronic diseases of the 
limbs, it is, I fear, very often resorted to in recent injuries earlier than it 
should be. Many limbs that have been removed, might probably have been 
saved; but where this cannot be done, it is rare that much inconvenience 
would follow from a little delay. 

In most cases of accident sufficienUy severe to justify amputation, the 
whole system has suffered a great shock, and an operation at this time, 
before reaction is fairly established, is very likely to cut off what little chance 
the patient might otiierwise have of recovery. While the extremities are 
cold and the action of the heart is feeble, the local injury is hardly, if at all, 
perceived, and adds nothing to the patient's sufferings. An operation can- 
not be required then; and yet how often it is done at that period; the better 
judgment of the surgical attendant sometimes being overruled by the impor- 
tunate interference of the bystanders. 

If the injury be not so serious as to cause almost immediate death, reac- 
tion usually comes on with proper management in a few hours, and then, 
if an operation be necessary, it can be done with a much greater prospect of 

With regard to the ages of the patients operated on, it appears that there 

Under 20 years of age 13, of this number 1 died. 

Over 20 and not exceeding 30 « 31, " 8 " 

» 30 " 40 " 9, " 3 " 

« 40 « 50 " 10, " 2 " 

» 50 «» 60 " 3, " 1 " 

Over 70 " 1, " " 

Whole number, 67. No. of deaths, 15. 
Boston^ March 24, 1840, 

Warren on Retention of the Placenta, 71 

Art. VI. On Retention of the Placenta. By Edward Warren, M. D. 
of Boston, Massachusetts. 

The management of the placenta, in cases where it does not come away 
speedily after the birth of the child, has in former times been the subject 
of much controversy. It seems now, however, to be pretty generally under- 
stood that it is not safe to wait long for the efforts of nature. Burns fixed 
the time which might elapse before interference was rendered necessary, at 
one hour only; and in this he is followed by Dr. .lames Hamilton and by 
Dr. Robert liCe, who have written recently on this and other subjects of mid- 
wifery. Dr. Collins mentions two hours as the general rule; Denman fixed 
four hours; and Dr. Dewees is averse to time being made a criterion upon 
any point in midwifery. 

In common cases, we know that within fifteen or twenty minutes after 
the delivery of the child, the pains return and the placenta is delivered with- 
out our aid. In other cases there is longer delay, but there is still no neces- 
sity for active interference. As a general rule it may be considered safe and 
useful; on the return of the pains or when they do not return in season, to 
pass up the right hand guided by the funis which is drawn down by the 
left, grasp the extremity of the placenta and by gentle efforts aid the action 
of the uterus for the expulsion of its contents — taking care of course neither 
to pull so steadily or so forcibly as to endanger the inversion of the uterus, 
or to rupture the placenta. By doing thus from time to time, the uterus 
may be excited to contract if it requires stimulus, and the moment will be 
ascertained at which the mass can be removed without force. Where this is 
done with care and attention, it can hardly happen that it will be left in the 
uterus or vagina, unless there is some particular cause for its detention. In 
very many cases of atony of the organ, it will probably be found sufficient. 
Where ii is not successful we have various methods to rouse the action of 
the organ and hasten the expulsion of its contents. When the uterus re- 
mains uncontracted, we of course employ friction and pressure upon the 
abdomen; stimulating injections, injections of warm water; injections of 
cold water into the cord, &c. before passing the hand into the uterus. 

The causes by which the placenta is retained in the uterus, are generally 
divided into three. The first cause consists in mere atony of the womb, or 
inability to throw off its contents. This is the most common one. The 
second, or the one that it is proposed to consider second, is the sudden or 
irregular contraction of the uterus by which its contents are enclosed before 
they have had time to escape. The third cause which is happily the most 
rare, is from adhesion of the placenta to the uterus itself. This is sometimes 
produced by falls or blows received upon the abdomen. In Dr. Collins's 
15654 cases, the hand was introduced into the uterus in sixty-six: thirty- 
seven of these were cases of atony; nineteen of irregular or spasmodic con- 

73 Warren on Retention of the Placenta, 

traction; and ten only were cases of adhesion. Six of these sixty-six were 
fatal, and these were all of the second kind. It is comparatively a rare 
thing then, to meet with any serious obstacle to the delivery of the after- 
birth. The quesiion, however, is not a less important one; how are we to 
act when instances of this kind occur? 

Among the older writers, there was much diversity of opinion in regard 
to the expediency of interference. Ruysch a physician of ninety years 
experience, was in favor of leaving the delivery of the placenta to the exer- 
tions of nature, because he had always found that separating it with the 
hands occasioned the most malignant symptoms, and frequently the death 
of the mother. Heister on the other hand observes that we 'are furnished 
with not a few instances where the mother has expired from retention of the 
placenta; for cases of which he refers to Leporinus Be Secufidinis. Vio- 
lent pains, floodings, malignant fevers, and death itself, he tells us, are the 
consequences of its non removal. Smellie is in favor of a middle course. 
After observing that not more than once in fifty or a hundred times, is there 
any thing to be done after the birth of the child; and that some of the 
ancients have alleged that there is no danger upon this account more than 
once in one thousand cases; he advises us not to torture nature when it is 
self sufficient, nor delay assistance too long; because it is possible that the 
placenta may sometimes though seldom be retained, and that the practitioner 
will be blamed for leaving it behind, if through any accident the womb 
should be inflamed and the patient lost. 

In order to the proper examination of this subject, let us consider in the 
first place, what are the dangers to be apprehended from the non-delivery of 
the placenta within a certain time after the birth of the child: and, on the 
other hand, what are the dangers of interference? Heister's catalogue of 
disasters as above named, are violent pains, floodings, malignant fevers and 
death. Flooding is the one which has been most feared. It is the one 
principally alluded to by Ramsbothan, and was the source of evil in nearly 
all of his large collection of cases. Denman entertains less fear of hemor- 
rhage. In a collection of twenty cases recently published by Dr. R. Lee, 
seven of which were fatal, flooding from retention does not appear to have 
been the source of trouble in any of them. The way in which the placenta 
is supposed in these cases to have been the source of mischief, is from the 
irritation it excited as a foreign substance, and from the absorption of pus 
produced by its putrefaction; at least this is the inference we must draw, if 
we suppose, that the retention of the placenta was really the cause of death. 
These cases will presently be examined. 

It is necessary according to Burns, Hamilton and Lee, to wait only one 
hour for the eflforts of nature, because the uterus and other parts contract 
so speedily; and they maintain that the difficulty is only increased by delay. 
Even at the end of one hour. Dr. Hamilton says, the vulva seems closed, and 
the vagina thickened, and as time advances these changes progress. The 

Warren on Retention of the Placenta, 73 

introduction of the hand into the uterus, they consider as much more easy 
and safe, than at any subsequent period. On the other hand, some writers 
consider the uterus as dilatable at a very much later period, as it is within a 
short time after its contraction. 

The dangers attending the forcible delivery of the secundines, are, 1st. 
That of producing hemorrhage: 2d. Of seriously injuring the patient by the 
effects attending the introduction of the hand. In the first (:> vision of cases 
in which the placenta is retained, that of atony, there is danger of hemor- 
rhage, whether the placenta be left in the uterus, or whether it be extracted, 
supposing it to continue in any degree adherent. In the second division the 
difficulty and the danger consist in the forcible dilatation of the uterus, and 
of its producing inflammation or the effects of shock or irritation. In the 
third class of cases, i. e., of adhesion, we have the dangers mentioned by Dr. 
Hamilton, of lacerating the uterus and of producing inflammation by the 
pressure of the fingers on the surface of this organ. 

There is this great difficulty in settling all obstetric questions; that pecu- 
liarities of habit and constitution have a greater influence in this than in any 
other branch of medical practice. One woman will survive the most omi- 
nous mischances, and almost any amount of rough usage, short of the forcible 
extraction of the uterus itself, by mistake for the placenta; another, under the 
best management and almost without any untoward symptom, dies suddenly, 
and without any apparent cause. Thence some practitioners are in the con- 
stant habit of interferring by the use of instruments, and otherwise, on very 
slight occasions of delay; while others object to such interference, unless it 
is manifestly and imperatively called for. The circumstances which occa- 
sion an unfavorable result are so obscure, that a practitioner who has adopted 
certain rules of action, will readily attribute his instances of success to these 
rules; while there are always causes enough to which he can attribute an 
untoward issue. In most of the fatal cases of retention of the placenta, the 
hand has generally been introduced one or more times into the uterus; other 
means have been resorted to, consultations held and the ^oman harassed and 
worried to such a degree, as might of itself be sufficient to account for the 
unfavourable progress and termination of the case. 

Smellie has ten cases in which the placenta was delivered with difficulty. 
In the first case, there had been violent hemorrhage which had ceased, but 
recurred upon the introduction of the hand, shortly after the birth of the 
child, for the extraction of the placenta. This was succeeded by faintings 
and death. In his second case, which was similar, he, in consequence, re. 
moved only those parts which came away with ease, prognosticating that the 
remainder would be expelled in a day or two, which accordingly happened, 
and without any bad consequences. In his third and fourth cases, the hand 
was introduced and the secundines extracted successfully. In his fifth case, 
the removal was accomplished with difficulty, the woman complained of a 
good deal of pain, lost an uncommon quantity of blood, and continued weak 

No. LI.— May, 1840. 7 

74 Warren on Retention of the Placenta. 

for a long lime. Upon this case, he remarks, that he has often thought this 
hurrying method unnecessary; that in other cases, when the edge of the pla- 
centa was found at the mouth of the womb, it has come down of itself at 
leisure, the woman has lost less blood, and recovered better than where force 
has been used to extract it immediately. In his sixth and seventh cases, 
the hand was introduced into the uterus, and the placenta extracted with 
success; in the former case after a lapse of several hours, and in the latter di- 
rectly after the birth of the child, the funis being broken by the midwife in 
attendance. In the eighth case, the secundines were extracted, leaving a 
part behind which came away in three days, without any inconvenience to 
the woman, but the smell and colour of the lochia. In the ninth case, the 
membranes were torn off and left behind for four or five days in the uterus, 
but were discharged at the end of that time without the slightest inconveni- 
ence to the patient. In the tenth case (communicated to Smellie by another 
practitioner), the placenta which adhered very firmly was removed piece- 
meal, sixteen hours after the birth of the child, but the woman died a few 
minutes after the operation. In this case, however, the woman was in con- 
vulsions when the practitioner arrived. The case therefore proves nothing 
with regard to the matter in question, since convulsions may occur after 
labour, under any circumstances; whether it has been slow or speedy, whether 
the placenta has been retained or delivered; and they are always dangerous. 
In this case, however, the fatal result seems to have been hastened if not al- 
together occasioned by the force .employed. 

Dr. Ramsbotham, in his Observations published in 1821, gives thirty-five 
cases of what he calls adherent, retained and disrupted placenta. In his first 
case of adherent placenta, the patient, a young and delicate woman, was de- 
livered at 12 o'clock. She suffered from excessive hemorrhage, and the 
placenta was removed by the introduction of the hand a little after 3 o'clock. 
She did well until the ninth day when she died suddenly. The body was 
not examined, and the cause of death was not discovered. In the second 
case, the patient when visited by Dr. R., three hours after the birth of the 
child, was in a state of almost incessant fainting; having lost a large quantity 
of blood. He immediately introduced his hand, found tlie placenta consider- 
ably adherent, but separated it very successfully, though not without an in- 
crease of flooding during the operation. The uterus contracted, but the 
patient died in an hour after he had left the house. In the third case, the 
patient died suddenly from loss of blood, before the placenta was removed. 
How far the efforts of the midwife to remove it before Dr. R. was called, 
might have contributed to the fatal result, we have no means of ascertaining. 
It would require too much space to go through with the whole of Dr. R's 
cases. He gives us twenty-four cases of adhesion; out of which twenty- 
were attended with flooding, and of these, nine including the three above 
alluded to, were fatal. His fifteenth and nineteenth were cases of adhesion 
with contracted uterus. Both terminated favourably after the separation of 

Warren on Retention of the Placenta, 75 

the placenta, by introduction of the hand. Case twenty-three, is one of 
injury from premature removal of the secundines in a case of twins; and case 
twenty-four is one of inversion of the uterus by pulling at the funis — fatal. 
All the simple cases of adhesion, therefore, were attended with serious flood- 
ing, and this is the only cause of evil alluded to. In most, if not in all, 
interference was rendered necessary from this cause. 

Dr. Ramsbotham gives five cases of " retained" placentae. He observes, / 
that in cases of atony, or the want of active contraction, where the insertion 
of the funis cannot be felt, no attempt for the present, at least, ought to be 
made to deliver the placenta by the funis; such an attempt, in the absence of 
contraction, would endanger an attack of hemorrhage on the rupture of the 
funis, and would ultimately be unsuccessful. After the lapse of a short time, 
temporary accession of after-pain is observable, and the uterine tumour is 
gradually diminished. In proportion to the degree of contraction and the 
frequency of its return, is the probability of the natural exclusion of the mass 
In question. Where there is a gradual draining of blood, the progress and 
effects of this drain must be carefully watched, and as soon as an impression 
is produced upon the system, the operator must introduce the hand and ex- 
tract. The loss of blood in extraction, he says, is usually less in this, than 
in the preceding case. In the case of sudden hemorrhage, immediate assist- 
ance is of course more imperatively required. 

In the second variety of *' retained" placenta, that caused by hourglass 
contraction, Dr. R. says, after waiting an uncertain time, hemorrhage gen- 
erally comes on and continues to increase. The difficulty is not discovered 
until the introduction of the hand. The contraction is overcome very gradu- 
ally, the operation causes great pain to the patient, and demands a great ex- 
ertion of fortitude on her part, as well as of patience on that of the accou- 
cheur. In the third form of "retained" placenta, that of globular contrac- 
tion of the organ. Dr. R. observes that it remains within the uterus, until 
time induces its removal, or the relaxation of the organ, with a subsequent 
effort, allows its escape. In this case, as there is little hemorrhage or other 
accidents threatening immediate danger, all appearance of hurry must be 
•avoided; the time of interference, he says, must vary according to the circum- 
stances, but he considers that there is little probability of its ultimate remo- 
val by relaxation and return of the contractile efforts. 

In case twenty-five, there was want of uterine action, attended with a con- 
stant draining of blood, repeated faintings, and other marks of j)rostration. 
She obstinately refused manual assistance, however, and when she was 
almost in a state of exhaustion, the uterine action returned contrary to Dr. 
R's expectations, and the placenta was thrown off just in time to save the 
patient's life. This took place sixteen hours after the birth of the child. 
Case twenty-six, one of twins, was attended with dangerous draining. The 
uterine tumour was found large, and no part of the placentae could be felt by 
the finger, on the arrival of Dr. R., some hours after the birth of the child. 
The placentae were removed by introduction of the hand, but the patient 

76 Warren on Retention of the Placenta, 

died. In case twenty-seven, the cause of retention was the same and attend- 
ed with violent flooding. The placenta was removed about four hours 
after the birth of the child, by introduction of the hand; contraction ensued 
and the flooding ceased. In case twenty-eight the uterus appeared paralysed 
by the efli'ect of an opiate. As there was no dangerous symptom. Dr. R. 
concluded to wait, and the placenta was protruded into the vagina after 
about nine hours. The twenty-ninth was a case of miscarriage of twins, 
in about the fifth month of pregnancy. There was no bad symptom, and 
he refused to ofl'er any manual assistance. Three days after the birth of the 
child, a part of the mass was removed from the vagina by the midwife, and 
in a few days more, the whole was thrown off*, without any alarming 

Disruption of the placenta, by which is meant the rupture of the general 
mass, leaving the broken portion behind in the uterus, attached to its original 
site, Dr. R. considers as in every instance big with impending mischief; and 
as generally, if not always, the result of mal-practice or mismanagement. A 
recurrence of after-pains, hemorrhage, succeeded by the expulsion of coagula, 
are the first symptoms produced. The temporary pains, after a day or two, 
terminate in a settled uneasiness, which increases and assumes the character 
of continued tenderness of the uterine tumour. This irritation soon extends 
to the system, producing rigor, restlessness, watchfulness, anxiety, and febrile 
symptoms. Pain in the head comes on, and increases till it ends in delirium. 
The dangerous symptoms progress, the general strength is exhausted, the 
pulse becomes quick and tremulous, the belly swells and is painful, the 
fseces and urine are expelled involuntarily, and death closes the scene within 
a week or ten days after delivery. The terminating symptoms resemble 
those of the last stage of typhus. If the retained portion should be fortunately 
excluded, the symptoms immediately begin to decline, and the patient shows 
signs of recovery. 

In other cases, the symptoms are of a milder character, a puriform dis- 
charge is kept up from the vagina and the patient gradually gets well. In 
every case. Dr. R. thinks the patient has to encounter considerable risk. — 
If she escape the immediate consequences of flooding, she will have to con- 
tend with subsequent symptoms arising from irritation and absorption; the 
progress of which is not under medical control. When these symptoms 
take place early, the case proceeds with great rapidity and the powers of the 
constitution soon give way. 

Case thirty was one, in which the attending practitioner had failed in his 
endeavour to introduce the hand. Dr. R. advised delay, as there was no 
flooding. The woman afterwards refused manual assistance in consequence 
of the pain she had already suffered. The next morning, the placenta w^as 
found lower down, and a greater part was removed by pulling at the cord. — 
About two days after, the remaining portion was thrown off", without the in- 
tervention of any bad symptom. 

The thirty-first was a case of excessive flooding, with a portion of placenta 

Warren on Retention of the Placenta, 77 

retained, l^he patient died under symptoms of exhaustion or low fever 
seven days after delivery. The thirty-second vi^as fatal on about the fourth 
day, under similar symptoms. In the thirty-third, some vascular portions 
were left, and came away gradually between the 23d and 28th of the month. 
In the thirty-fourth case, a portion was retained for fifteen days, after which 
the patient recovered rapidly. In the thirty-fifth case, the placenta was 
thrown off entire, four weeks after the birth of the child between the fourth 
and fifth month of pregnancy. It was then expelled in a perfectly fresh 
state. From this and several of the other cases, we may learn that the re- 
sources of nature are much greater than we should expect, from what has 
been laid down, in medical books, in regard to the necessity of the speedy 
delivery of the secundines. It is true, according to general belief, that in the 
case of premature delivery, the placenta may remain longer in the uterus 
than under other circumstances, but the other cases which have been men- 
tioned were those of patients confined at their full time. 

Dr. Ramsbotham thinks that unless there is some obstruction, the placenta 
is generally delivered within an hour; and that two hours is ample time to 
delay assistance. He objects, however, to any specified time. From ex- 
amination of his cases, in most of which he attended in the capacity of con- 
sulting physician, or at least after the child had been delivered by others; 
it appears that in many he found it necessary to forbear manual assistance: 
in others, the patients refused it and yet the termination was favourable. — 
Although he was called at a late hour in all of these cases, he does not ap- 
pear to have been in a hurry to assist unless the circumstances imperatively 
demanded it; the principal circumstance which required it being hemorrhage. 

Dr. Robert Lee has published in the 29lh volume of the London Medical 
Gazette an account of twenty cases of retained placenta, seven of which were 
fatal; and in thirteen, there was more or less difficulty and danger produced 
from portions or the whole of the placenta being left within the uterus, be- 
yond the usual period. He says that, in all cases, if the placenta is not ex- 
pelled in an hour it should be withdrawn artificially, by passing the hand 
along the cord to its insertion, expanding the fingers, and grasping the whole 
mass or as much as can be severed and brought away. This course is the same 
with Dr. Hamilton's.* 

In the first of these cases, the patient was seized soon after delivery with 
pain in the region of the uterus, quickness of pulse and respiration. The skin 
assumed a peculiar dusky hue, and pains were felt in the principal joints. 
She died on the twenty-ninth day after confinement; and on inspecting the 
body, there was found a small portion of placenta adhering to the uterus near 
the fundus; and the veins of the part were distended with pus. 

In the second case, a large portion of the placenta was left in the uterus. On 
the third day after delivery, there was fostid dark-coloured discharge from 
the vagina; pulse feeble; countenance haggard; and delirium. The orifice 

* Third Report on Difficuh Cases in Midwifery —Case XLVIII. 


79 Warren on detention of the Placenta, 

of the uterus wag so firmly contracted that two fingers could not be introduced 
and the placenta felt. Two doses, of thirty grains each, of ergot, were given 
but without any good effect, and the patient died on the fifth day after deli- 
very, under the circumstances usually observed when a putrid animal poison 
is introduced into the system. A large portion of placenta was found in the 
uterus in a very putrid state. 

In the third case, the patient is said to have died on the eighteenth day after 
delivery, from putrefaction of the placenta. She had appeared to do well 
for five days; then the pulse rose to 120; rigors came on with loaded tongue, 
sickness at stomach, dirarhoea, slight occasional cough, and hurried breathing. 
She died without any suspicions being entertained of disease of the lungs. 
A portion of the placenta in a sloughy state was seen hanging through the os 
uteri; and filling up the whole upper part of the vagina. Pus was found in 
the vessels of the uterus. The lining membrane and muscular coat of this 
organ where the placenta adhered were soft, and as black as ink. Pleura on 
right side extensively inflamed. Right inferior lobe hepatized, and several 
deposits of pus in the substance of the lungs. The pleura at one point ap- 
peared to be destroyed by sloughing or gangrene. 

In the fourth case, the placenta adhered with unusual firmness to the uterus. 
An alarming hemorrhage occurred after birth. Several unsuccessful attempts 
were made to extract the placenta, and it was uncertain at the time whether 
the whole had been removed or not. A serious affection of the brain took 
place, and she died about ten days after delivery. The superior longitudinal 
sinus of the brain was found filled throughout a greater part of its extent, with 
a solid coagulum of fibrine, and all the veins emptying into it on the right 
side distended with fibrine. Veins on the left side in a similar condition but 
to a less extent. There was no trace of inflammation about the uterus and 
all its vessels were healthy. The placenta adhered firmly, was harder than 
natural, and of a yellow colour. 

In the fifth case, contraction of the cervix uteri took place immediately 
after delivery of the head, so that much force was required to extract the 
shoulders and all attempts to remove the placenta were ineflfectual. Seven 
or eight days after delivery, another attempt was made to extract the placenta, 
a foetid discharge and symptoms of peritonitis having come on. A portion 
was thus removed. The patient died at last of peritonitis. 

In the sixth case, the placenta was extracted entire by dilatation of the neck 
of the uterus and introduction of the hand, two hours after delivery. On the 
ninth day the pulse was quick and feeble. There was tenderness over the 
uterine region, dyspnoea, and pain in the left side of the chest. She died 
after a few days, and the upper lobe of the right lung was found covered with 
a thick layer of false membranes and hepatized. There was a considerable 
quantity of fluid eflfused into both sacs of the pleura. Considerable curvature 
in the upper part of the spine. 

The subject of the seventh case was seen by Dr. Lee twenty-two hours 
after delivery. The pulse was rapid; discharge from vagina offensive, and 

Warren on Retention of the Placenta. 79 

neck of uterus contracted though not firmly. The hand was passed gradu- 
ally into the uterus, and the placenta felt adherent throughout to its surface. 
A small portion was left in, and removed by a second introduction of the 
hand; great faintness followed. For a time she appeared to recover, but 
towards the end of the month, the lower extremities swelled, she became 
delirious, had the usual symptoms of inflammation of the uterus, and died. 
All the femoral and pelvic veins were found plugged up with coagula. The 
uterus was twice its natural size and flabby. No portion of placenta was 
found within it. 

In the first of these cases, the symptoms seem to have come on directly 
after delivery. May it not be said that they arose more probably from ex- 
haustion, than from retention of the placenta? and is not the retention in this 
and similar cases an effect rather than a cause? 

In the fourth case, an affection of the brain came on, in consequence, we 
are to infer, of irritation produced by a large portion of the placenta remain- 
ing in the uterus, this portion continuing perfectly sound. But as several 
unsuccessful attempts had been made to withdraw it, the irritation produced 
by these efforts, the anxiety of mind occasioned by its retention, the hemor- 
rhage, or other unknown causes, may have been as instrumental in the 
affection of the brain as the continuance of the placenta in the uterus. We 
know that such affections are by no means rare after delivery, and in a large 
number of cases the cause is altogether hidden. 

In the other cases, it is equally impossible to say whether the retention of 
a portion of the secundines was or was not the cause of the fatal issue. 
There may have been suflicient evidence to satisfy the physicians in attend- 
ance that such was the fact; but the brief manner in which the cases are re- 
corded prevents it from appearing. If we consider the cause of death to be 
really such as supposed, our inference must be highly unfavourable to the 
practice of Dr. Hamilton and of Dr. Lee; because, by their process of ex- 
traction, a portion of the placenta must inevitably be left in the uterus in 
almost every case, at least, where there is any adhesion. 

The subject of Dr. Lee's next case was delivered on the 28th of June, and 
seen by him on the 7th of July. Hemorrhage had occurred after delivery, 
and the placenta was brought away with difficulty, and in a ragged state. 
July the 7th, the pulse was 120; great giddiness and beating of the temples; 
offensive discharge from vagina. Injections of tepid water were adminis- 
tered with a weak solution of chloride of soda; cathartics, nourishing diet, 
wine, and quinine were exhibited, and in a few days the retained portion of 
the placenta was expelled, and she speedily recovered. 

In the ninth case, the larger portion of the placenta was removed two 
days after the child's birth. There was at this time rapid pulse, loaded 
tongue, nausea, great headache, dark-coloured discharge from vagina. She 

In the tenth case, the placenta was retained eighteen hours, and then re- 
moved by introduction of the hand. No bad symptom followed. The 

80 Warren on Retention of the Placenta. 

next six, are cases of successful removal within a few hours after delivery, 
by introduction of the hand or fingers, in five of them after the cord had been 
torn off. 

In the seventeenth case, the woman was delivered of a child at the sixth 
and a half month. The cord had been broken off by the midwife, and the 
parts were so much contracted, that the hand could not be introduced with- 
out too much force. The following morning a brisk cathartic was given, 
and in the evening the placenta came away whole, without any help and 
with no bad result. 

In the eighteenth case, the patient had been delivered of a dead child 
thirty-four hours before she was seen by Dr. Lee. Discharge from vagina 
extremely foetid. Three fingers were gradually introduced into the orifice 
of the uterus; the placenta seized and brought away. Recovery very favour- 

In the nineteenth case, the patient had been delivered of a dead child, of 
six and a half months, twenty-four hours before Dr. Lee saw her. An 
attempt to withdraw the placenta failed. The next morning, a cathartic 
was given, which excited A'omiling and purging, and, during its operation, 
the placenta came away in a yellow indurated state. No bad symptom 

In the twentieth case, the placenta was expelled from the uterus into the 
vagina, but prevented from descending further by a broad smooth band — 
probably an original malformation — passing from the anterior to the pos- 
terior surface. The placenta was divided into two portions with a pair of 
scissors, and immediately came away. 

In several of the cases which have been noticed above, ergot was given 
in large and repeated doses; but with no effect in exciting a return of uterine 

In the same volume of the Lond, Med, Gazette, (page 922,) two cases of 
adherent placenta are given by Mr. Chatto. In the first, the placenta was 
peeled from the inner surface of the uterus, not long after the birth of the 
child. The recovery was slow, and long doubtful. It was attended with 
the exhaustion, uterine tenderness, and other symptoms, which occurred in 
the cases of retained placenta above cited. His second case is the same with 
the seventh of Dr. Lee's, but given in detail. 

In considering the whole of the cases referred to, we perceive that it was 
necessary in several of them for the most strenuous advocates of speedy re- 
moval of the placenta, to allow it to remain until thrown off by the efforts 
of nature; as they believed the danger of removing it to be greater than that 
of allowing it to remain. Yet the rule they lay down is, that the placenta 
must be removed by introduction of the hand in all cases, if not naturally 
expelled within a very short time. In these instances, and in several where 
the patient herself obstinately refused manual assistance, we see that the 
placenta was retained for sixteen or eighteen hours, and even for several 
days, and then thrown off naturally without any evil consequence. We see, 

Warren on Retention of the Placenta, 81 

therefore, what the resources of nature really are. Secondly, taking into 
view the whole of these cases, we see that the danger of hemorrhage is not 
so great as was formerly considered. Of course where there is much dis- 
position to flooding, it may render interference imperative; but where no 
such disposition is evinced, it is not an occurrence we are greatly to dread; 
though a careful watch should be kept upon the patient so long as the se- 
cundines are retained. Thirdly, we may gather from these cases the con- 
clusion, that when a portion of any considerable size is left behind, the 
consequences are as bad as when the whole is retained; and that even the 
smallest portion may be a cause of serious mischief, provided the conse- 
quences recorded were really the consequences of this retention. We have 
reason to suppose that a natural and healthy action for the removal of the 
uterine contents will take place sooner and better when there has been na 
interference and when the whole portion is left to excite such action, than 
where only a small part remains. In the latter case, we can hardly expect 
its removal except from putrefaction.* 

In some of Dr. Lee's cases, the unfavourable symptoms occurred too soon 
for them to be properly attributed to the retention of the placenta, and in 
perhaps most of the others, there is no proof that this was the cause of the 
evil and not merely a consequence. 

The continental writers, many of them, recommend delay unless symp- 
toms of danger occur. Baudelocque says that in atony of the uterus, when 

* It would appear that the placenta may occasionally be absorbed without becominfj 
purulent. Dr. Naegele has given a number of cases of this kind, an account of which 
may be found in the fourth volume of this .Tournal, page 244. Dr. Gerbillot, of Lyons, 
has also furnished a case, vide vol. v, page 530. In this there was no smell or colour in 
the lochia; the menses returned in about three months; and in due time the patient again 
was delivered of a healthy child. Dr. Porcher, of South Carolina, has given an interest- 
ing account of a case, vol. x, page 391, illustrating the harmlessness of retention in some 
instances. In this the retention was apparently permanent. There was foetid discharge 
and great constitutional irritation for about three weeks after delivery, when the patient 
became well; and continued so with slight exceptions, until last seen by him, about eight 
months after her confinement. Dr. P. supposes that, in consequence of the adhesion, the 
placenta became organised. I may here refer to the other papers and selected cases 
which have been published on this subject, in this Journal; and particularly to that of 
Dr. Lindsly, of Washington, vol. xix, page, 337, to which I am very happy to appeal as 
sanctioning the view which I wish to advocate. Dr. Heustis, vol. xv, page 106, has de- 
tailed two cases of adherent placentae, in which the patients eventually recovered, but 
not without severe suffering. In the same volume, page 113, is a paper by Dr. Charlton» 
of Georgia, on the^ danger of retention of the placenta; and, at page 370, a case by Dr. 
Harrison, ef Louisville. At page 524, vol. xi, is a case occurring in the practice of Mr. 
Shorland, of London, which illustrates the remarkable powers of nature, in the removal 
of a placenta and a dead foetus piecemeal; the patient recovering so completely as to give 
birth to another child within a short period. Other cases of retention and of adhesion 
may be found, vol. xvi, page 235; vol. xvii, page 527; vol, iii, page 224; vol. iv, page 51 U 
most of which afford evidence that the placenta may be retained without injury under 
certain circumstances. 

82 Warren on Bdention of the Placenta. 

there is no hemorrhage, no attempt should be made to extract until the 
uterus recovers its lone. Capuron says that when the placenta is retained 
by inaction, or by spasmodic contraction, or by morbid adhesion, all attempt 
at extraction should be delayed. Gardien says the same in cases of spas- 
modic or natural contraction of the neck of the uterus. 

Velpeau, in the case of atony of the uterus, states that the remedy is some- 
times a little wine; sometimes light and nutritious food; sometime rest; but 
frictions and pressure upon the abdomen are always useful. In the cJPse of 
rapid contraction, patience and friction on the abdomen. He does not con- 
sider it allowable to introduce the fingers for dilatation of the neck, unless 
there is pressing danger. In the case of strangulation of the placenta by 
irregular contraction, he says, when the uterus is left to itself, its contractions 
remove the difnculty; and these may be excited by friction upon the abdo- 
men, and by skilful traction of the cord. Mr. Velpeau seems to be more in 
favour of interference than the older French writers; yet we find he goes no 
farther than this. Now can we suppose that he would state the resources of 
nature to be such, unless he had witnessed them? or can we believe that 
Baudelocque, Capuron, and Gardien would lay down such rules for non- 
interference unless they had received sufficient evidence that nature was 
capable of doing her work unassisted, especially as the opportunities for 
observation in obstetric cases are greater in France than in most other 
places? With regard to cases of adhesion, Velpeau believes that actual ad- 
hesion is less common than is generally supposed. In slight cases, he says, 
it can be overcome by skilful management of the cord. He alludes to the 
opposite opinions in regard to speedy action or delay, and to the statements 
of Haller, Sandifort, and M. de Saint Amand, in regard to rupture, inflam- 
mation and gangrene of the uterus in consequence of eff*orts made to over- 
come adhesion; whilst, if putrefaction took place, it would come away piece- 
meal with the lochia, and absorption would always be prevented by injec- 
tions; so that the dangers which result from its extraction are greater than 
those from delay. On the other hand, Velpeau states that serious conse- 
quences are often the result of its retention, and that the injury produced by 
introduction of the hand is owing to want of skill in the practitioner. He, 
therefore, wails some hours if there is no particular circumstance that calls 
for speedy action; and longer if the woman is of good constitution and free 
from anxiety. 

As Dr. Hamilton states, that from the earliest period of his life he has 
always acted upon two rules: the first of which is, always to interfere on 
the very first threatening of hemorrhage; and the other, to wait no longer 
than one hour, where there was no untoward symptom, he can be no judge 
of the safety of delay, or of the resources of nature when left to herself. 
On the other hand, the advocates of delay must speedily have means of 
ascertaining if nature was altogether incompetent to the task. 

Dr. Hunter, in consequence of the dangers which he found to attend the 
forcible removal of the placenta,- adopted the rule of leaving it entirely to the 

Warren on Retention of the Placenta. 85 

exertions of nature. His pupils, we are told, followed this course; and for 
some time all went on well, the patients were generally delivered within 
sixteen or eig^hteen hours, without any bad result. Finally some unfavour- 
able cases occurred, and the practice was changed. 

Dr. Hamilton tells us that his first rule — to interfere upon the slightest 
appearance of hemorrhage — is one which is better observed by the continental 
practitioners than by the British. He says, also, that it has been a general con- 
clusion among British practitioners, where there are no untoward circum- 
stances, that lime and patience are all that are required. There are certainly- 
few who are willing to go as far as he does in the practice of hasty interference. 

Retention from atony of the uterus, and hourglass contraction, Hamilton 
maintains to be always the result of bad management. Morbid adhesion of 
the placenta, he says, is the only cause he has met with for the last thirty 
years, in cases of which he has had charge from the beginning. In opposi- 
tion to the opinion of Ramsbotham, he maintains that this condition can be 
discovered by the symptoms before introducing the hand. 

*' When the placenta morbidly adheres, a gushing of blood follows the birth 
of the infant, uterine contractions succeed, each pain being followed by ano- 
ther gush, while the uterus is contracted into a round form, and yet there is 
no lengthening of the cord." 

Dr. Hamilton employs the same method in this as in other cases. *' Pres- 
sure, for the purpose of separating the mass, is made exclusively upon the 
foetal surface; and when all the separate portions are detached, they are to 
be pushed down into the vagina, after which as in the former case, the pari- 
etes of the uterus are to be forced into contact; and any coagula or remains 
of the secundinea are to be scooped out in the course of withdrawing the 
the hand." He objects to the common practice of peeling off the placenta; 
the hazard of exciting inflammation on the surface of the uterus by the pres- 
sure of the fingers; and secondly, the great risk of lacerating the substance of 
the uterus, by tearing off a part of the placenta literally blended with it. 

Dr. Hamilton tells us that his experience has proved to him that this prac- 
tice is safe and judicious. The uterus contracts firmly upon the portions 
that are left, when it is necessary to leave any; there is no danger of hemor- 
rhage, and when the indurated part separates by sloughing, the probability 
is it may be thrown off by the natural efforts, failing which its expulsion may 
be promoted by artificial means. If it was really the case that the portion 
thus left could do no harm, one strong objection against interference would 
be removed: for hardly any one will deny that this process must be attended 
with much less hazard and inconvenience than the one to which he objects. 
But if on ihe other hand, the retention of a portion of the placenta is as dan- 
gerous as the retention of the whole; and if we have really less to hope from 
the natural efforts in the former case than the latter, our conclusion as to the 
value of this process must be different. The objection to a fixed time for 
inteference, especially to so short a lime, would remain at any rale. The 

84 Warren on Retention of the Placenta, 

proper time must vary in every case. Older practitioners will of course 
always be guided by their own opinions and experience; but to the novice, the 
rule that he must proceed to the extraction of the placenta in all cases at the 
end of one hour, must be highly mischievous; and the more so as it allows 
him no time for obtaining the aid of other professional advice. 

In case of hemorrhage, or other unfavourable occurrence, it maybe neces- 
sary to proceed to the removal of the placenta at once. Perhaps, even in 
this case, nature will do more for herself than we are disposed to admit: 
still the universal practice is to adopt immediate measures. We should be 
highly censurable in allowing our patient to lose a large quantity of blood; 
or in allowing a dangerous drain to go on while we stood idle; and this is 
the only manner in which we can interfere to advantage. The duty is there- 
fore imperative, to remove the placenta at once in the best manner it can 
be done, and insure the contraction of the uterus as soon as possible. At- 
tempts may indeed be made to produce this contraction, and to arrest the 
flooding by other means in the first instance, and we must be governed by 
the urgency of the case as to the time we may allow those means. On the 
other hand, supposing that copious flooding has taken place after the birth 
of the child, and ceased before our arrival; the case is different. More blood 
will necessarily be lost in the operation, and if the patient is already ex- 
hausted, this cannot be without danger. Our duty is then to delay and 
watch. In the cases of atony of the uterus, we have the greatest reason to 
hope for benefit from delay, and unless a draining is going on, there is less 
danger from such delay. In such cases, we must use our judgment even 
whether the patient shall be allowed entire rest, or whether we shall con- 
tinue our eff'orts by friction, &c., to promote contraction of the uterus. In 
some cases, entire rest is of most importance. In atony of the womb, the 
danger of hemorrhage is less than in the cases of adhesion. 

Dr. Dewees, with great reason, disapproves of time being made a criterion 
in cases of midwifery. Before the birth of the child, the pains which have con- 
tinued regular, for hours, will sometimes subside and not return for twelve 
or twenty-four hours; and, in some cases, not for days. We do not, in 
these circumstances, think it necessary to proceed at once to extract the 
child. It probably would be done by many practitioners, if it could be 
without occasioning the certain destruction both of child and mother. For- 
tunately it cannot be done; and these cases often terminate even more safely 
than those where the progress of labour is rapid. In the same manner, in 
some cases, owing to prostration on other causes which we cannot divine, 
the pains which generally return speedily after the child's birth, will be en- 
tirely wanting. The fact is, the uterus is a whimsical organ, and the attempt 
to confine it to regular rules and times of action, is not only diflicult but 
dangerous.. In some of the cases which have been cited, its action was 
checked by opiates, in others by exhaustion. Now as the degree of exhaus- 
tion will depend upon the constitution of the patient, the difficulty of the 

Warren on detention of the Placenta. 85 

labour, and other circumstances of the case, it is by this condition that we 
must be governed in its management. Sometimes the delay of uterine 
action will be owing to causes altogether hidden from our inquiries. We 
have, however, every reason when there are no unfavourable symptoms to 
expect that it will return after a longer or shorter time, and that the labour 
will be favourably terminated by spontaneous efforts. We may, therefore, 
wait securely, merely employing such means as have already been men- 
tioned: to wit, friction and pressure externally, injections if we judge expedi- 
ent, and gentle traction. Velpeau notices, however, that when the uterus is 
in a state of atony there is more danger of its inversion by pulling on the 
cord, than under other circumstances. It will evidently be better if we can 
promote the expulsion of the mass by exciting, in the first place, the con- 
traction of the uterus. When there are no bad symptoms, it will very 
rarely be necessary to introduce the hand into the uterus. Dr. Collins in- 
troduces it for the purpose of stimulating the organ to contract. When other 
measures have failed it is hardly probable that this will succeed before the 
removal of the placenta; but the attempt should undoubtedly be made when 
it has been determined to introduce the hand, and at all events after removal 
of the placenta, the hand should be retained in the organ until it contracts 
upon it. The greatest reason for delay in these cases, however, is that when 
the placenta is removed. While the patient continues in a state of prostra- 
tion it may be exceedingly difficult to make the uterus contract, and a dan- 
gerous draining of blood may take place. 

In the second condition of retained placenta; that produced by hour-glass 
contraction, the rule is to pass up the fingers and introduce them slowly 
and successively into the neck of the uterus; making them form a conical 
wedge, and thus overcome the contraction. That there is both difficulty 
and danger in this process, whether applied to the hour-glass or the natural 
contraction if not evident from reasoning, is proved by the cases of Dr. Col- 
lins, his six fatal cases being all of this kind. We might naturally suppose 
that the spasmodic action would go off of itself after a short time, and this, 
as we have seen, M. Velpeau and the other French writers encourage us to 
expect. In the case of what has been called spasmodic contraction of the 
OS uteri, and which Velpeau considers as merely the natural but too sudden 
contraction, he advises, in like manner, that the remedy be patience and 
gentle friction upon the abdomen. A case of this kind occurred recently to 
the writer. A lady was confined of a six months child. After the labour 
had been going for some time, the hand of the fcetus was found in the vagina. 
As the foetus was found to be lying quite loose in the uterine cavity, the 
pains very strong, and parts fully dilated, the hand was put back and the 
feet seized and drawn down. In this manner, the body was delivered at 
once, but the uterus suddenly contracted, the pains grew slight, and there 
was much diflnculty and delay in delivering the head. The uterus then con- 
tracted firmly into a ball, and it was found impossible to remove the pla- 
No. LI.— May, 1840 8 

B6 Warren on Retention of the Placenta, 

centa without violence. As she was perfectly comfortable, and there had 
been no loss of blood, and seemed to be no danger of any such loss, I 
thought it best, after wailing about an hour, to abandon the attempt to deliver 
the placenta. The next morning, about nine hours after the birth of the 
child, I found her still very comfortable, though her sleep had been inter- 
rupted by slight pains which had been occasional through the night, and still 
continued. Upon passing up the hand guided by the cord in the usual man- 
ner to its insertion, I succeeded after a few gentle efforts, during the pains, 
in removing the placenta, a solid mass having the perfect pear shape form 
of the uterine cavity. The patient suffered no inconvenience; in a few 
days she was about the house, expressing herself and appearing as well as 
if she had never been confined. As she felt herself perfectly well, it was 
impossible to keep her within rules, and she left the city within ten days 
after her confinement. If force had been used, however cautiously or 
gently, to dilate the os uteri, she must have suffered severely. After such 
rapid contraction, the os uteri is doubtless contracted much more firmly at 
first — whether there be or be not spasmodic action, than after a few hours 
rest. After a short rest, the organ will generally renew its efforts for the 
expulsion of its contents. What then is the consequence when the placenta 
is left within the organ thus contracted? Where there are no untoward cir- 
cumstances, the same course will be pursued as in the case just mentioned. 
The pains will not altogether subside, and the vessels of the placenta will 
be emptied of blood, it will be compressed into a solid mass: and be finally 
excluded without bad consequences of any kind. I repeat that we have 
more reason to expect the natural and healthy exclusion of the mass when 
left entire, than when the larger portion has been removed; or when the 
woman has been harassed by continued efforts for its delivery. In many 
of the cases we have cited, the probability is that the natural exclusion 
would have been effected sooner had not the various attempts to -promote 
delivery by the introduction of the hand and other measures, and the con- 
sultations held by the anxiety thus cited, interfered with the operation of 
nature. When a small portion of the placenta only is left, we are not to 
expect its exclusion before putrefaction commences. Even when this is the 
case; or when the whole has been left, and owing to any particular cause, it 
has not been excluded before gangrene has commenced, it will still generally be 
thrown off without injury. Fatal results will sometimes occur, but I main- 
tain that we have no proof that these results are attributable to the retention; 
and that they are not, at least sometimes, the effect of a common cause. 

I come now to the most difl[icult condition — that of Adherent Placenta 
In this case, we have more danger of hemorrhage to apprehend, than in 
either of the others: — whether we remove it at once or let it remain. Dr. 
Ramsbolham remarks that his 15th, 18th and 19th cases *' prove demonstra- 
tively (if such proofs were necessary) the utter inability of the uterus to 
detach the placenta under such circumstances of morbid adhesion; and the 

Warren on Retention of the Placenta. 87 

necessity of the introduction of the hand for its manual separation." He 
considers the natural resources of the system as altogether inadequate to 
effect the separation. We have then to choose between the common prac- 
tice, and that of Dr. Hamilton. We are thus placed between Scylla and 
Charybdis. In the former case, according to him, we incur the hazard of 
exciting inflammation of the surface of the uterus, and of lacerating a por- 
tion of its substance. On the other hand, if we employ his procedure, we 
have almost the certainty of leaving a portion behind. We have, at any 
rate, this certainty; that if we always persist in removing the whole of the 
adherent portion we shall sometimes lacerate the uterus; and sometimes 
produce a dangerous degree of irritation and sometimes a dangerous hemor- 
rhage: on the other hand, if we leave the portion which adheres too firmly 
to be removed without violence, we shall sometimes have hemorrhage, and 
sometimes results from irritation and putrefaction at least as unfavourable as if 
the whole placenta had been retained. Under these circumstances, is it not 
worth consideration whether the dangers of separation and extraction are 
not as great as those of delay; and whether nature has not really some 
resources even in this case? 

It seems to me that in obstetric cases, we do not place half as much con- 
fidence as we might do in the resources of nature. Might we not reasonably 
expect that as soon as the placenta is no longer needed, nature would set 
about removing it in a healthy manner? When we know how much is done 
by the animal economy in the removal of the foreign bodies lodged in diffe- 
rent parts of the body, and how much is done also in cases of extra-uterine 
foetation, and even in many cases of miscarriage — have we not reason to 
expect what is really a much slighter exertion of the vis medicatrix? We 
know also how great the powers of the system are, for the removal of redun- 
dant or diseased portions. The connection of the placenta with the uterus is 
in general severed either at the birth of the child or within a short time after. 
May we not reasonably suppose that this separation may sometimes be 
delayed a little longer than usual, but yet be completed naturally? Where the 
adhesion is morbid, the difficulty of separation must be greater; but yet in a 
person of good constitution, where it is notcomplicated by other unfavourable 
circumstances, it may be effected naturally. At the worst, when putrefac- 
tion takes place, the connection will of course be dissolved. The opinion 
of Velpeau upon this subject, has already been quoted. The course which 
he recommended — to wait some hours where there are no circumstances 
that call for speedy action; seems to be the most rational. If it be allowed, 
as I think it must be from what has been said, that there is danger in the 
manual separation of the placenta, we ought to be certain that the conse- 
quences of delay will be still more dangerous, before we resolve upon inter- 

However it may be in other branches of medicine, in midwifery the great 
danger is of doing too much. There is every thing to lead us to interfere 

88 Mutter's Case of Rigidity of the Lower Jaw. 

when there is any apology for our doing so. Nothing is more difficult than 
to stand by the patient who is in a state of suffering and alarm and see hour 
after hour pass without our doing any thing to relieve her. In such cases it 
requires more fortitude to forbear, than to render assistance. 

After the birth of the child the woman naturally expects to be free from 
further trouble; and the accoucheur, as well as the patient, very probably 
worn out with the tediousness of the labour, has his own desire to escape 
added to his wish to save his patient farther anxiety and delay. Under such 
circumstances, the temptation to finish the labour at once, by removing the 
placenta, is very strong; and there is much more danger of rashness than of 

It will surely not be supposed from what has been written, that I would 
wish the secundines to be abandoned to the natural efforts after the birth of 
the child, as a general rule. It will always be desirable to have them come 
away as soon after the usual time of waiting, that is to say, the first fifteen 
minutes, as possible. I believe much can be done by judicious assistance, 
where the natural efforts are insufficient; and that cases which require 
delay will be rare. My object has been to show that the placenta may be 
left in the uterus with safety, when there are no unfavourable symptoms, and 
that the danger of forcibly removing it, will often be much greater than 
that of allowing it to remain. I believe that a general rule requiring the 
mass to be removed at all events, and especially within a certain time, is 
highly pernicious. The practitioner, however, is not discharged from close 
attendance until it is removed, nor can the patient be considered exempt 
from danger. 

Art. VII. — A case of Rigidity of the Lower Jaw, cured hy division of the 
anterior portion of the Masseter muscle of the left side. By Thomas D. 
Mutter, M. D., Lecturer on Surgery, &c. 

In January, 1839, I was requested to visit Harriett Ann Wolcott, aged 16, 
originally of Milford (Delaware) but now residing at No. 41 Cherry Street, 
for an affection of the mouth under which she had been labouring since her 
fourth year. It appears from the history of the case, that from some cause or 
other, she was seized when about four years old, with acute inflammation of 
the cheek which terminated after a long time in resolution, but in consequence 
of having been obliged to keep the mouth nearly closed during the whole 
treatment, a permanent rigidity of the masseter or a portion of it, on the 
affected side, was produced. Upon examination the left side of the jaw ap- 
peared much smaller than the right, and the integuments about the chin (on 
the same side) were much more closely connected with the bone, than is 


Mutter's Case of Rigidity of the Lotver Jaw, * 89 

usual. The whole left half of the inferior maxillary bone, is in reality 
smaller than the right, and instead of presenting the natural angle at the junc- 
tion of the ramus with the horizontal portion, is rounded off, so that it ap- 
pears much straighter than it should be. There is no scar, nor any evidence 
of previous ulceration either within or without the cheek, neither does there 
exist any adhesion between the cheek and bone, but a strong fibrous band 
formed of the anterior portion of the masseter muscle was readily detected 
by introducing the finger between the teeth and cheek. This band is so 
short as effectually to prevent any thing like motion (except to a very limited 
extent) of the inferior maxillary bone, and the space between the upper and 
lower teeth is so small that an instrument only three lines in thickness can 
freely be introduced between them. The patient is of course unable to chew, 
and has lived almost exclusively upon broths; nor can she protrude the 
tongue; and her teeth, in consequence of the impossibility of passing a brush 
between them, are in a very bad condition. Her articulation is also exceed- 
ingly defective. 

From the peculiar malformation of the jaw it became a question whether 
or not a division of the masseter muscle would be productive of much benefit. 
In as much, however, as the operation was very simple, but slightly painful, 
and above all attended with little or no risk, I determined to perform it, and 
afterwards endeavour by means of a lever, gradually to force the jaws apart. 

Having placed my patient in a good light, I passed the forefinger of my 
left hand along the space between the cheek and teeth until it was arrested by 
the band already alluded to. She was then requested to open her mouth as 
much as possible in order that the band might be put upon the stretch. — 
Using my finger as a director, I next passed along it, an instrument shaped 
like a common gum lancet, though larger, and having but one cutting edge, 
until its point rested behind the band. By pressing firmly upon the handle, 
the blade was made to penetrate the masseter muscle about its lower third, 
nntil the point could be felt between the muscle and integument. The band 
was then divided by drawing the knife forwards and at the same time direct- 
ing it outwards and downwards. The section was indicated by a slight snap, 
and the propriety of the operation at once made manifest by the improvement 
in the case. For example the finger could now be passed between the teeth, 
which before the operation was impossible. The hemorrhage was slight 
and the pain scarcely complained of. The oozing of blood having in a 
measure ceased, I next introduced the lever (see fig. p. 91) with the blades in 
contact, and adjusted them accurately to the dental arches; the screw was 
then turned until the patient complained of pain. The space between the 
teeth was now large enough to permit the finger to be passed to the fauces, 
or to speak more accurately, it was about half an inch between the incisors. 

The patient was put to bed with the head elevated, and ordered to be kept 

A few hours after the operation she was seen by two of my pupils, Messrs. 


90 Mutter's Case of Rigidity of the Lower Jaw. 

Van Wyck and Finlay, who reported that she complained of slight sore- 
ness about the part, but had no headache, fever, or any thing, in short, 
requiring attention. 

On the following morning when I saw her, the same favourable condition 
of things obtained, and although she had worn the lever all night, there was 
but very little pain, and no swelling in or about the cut. The instrument 
was removed for a short time in order that a little nourishment might be 
taken — when again introduced, I found that several additional turns of the 
screw might be made, and I succeeded in increasing, by three or four lines 
the space between the teeth. 

Nothing of any material interest occurred in the subsequent treatment — 
every day the screw was turned a little, and after the fourth or fifth, she was 
allowed to pass an hour or two without the instrument. Gradually this 
period was increased, and at the present time she wears the screw only 
at night. During the day she wears a small plug of ivory between the 
molar teeth, and is enabled at the same time to pursue her usual task, (gold 
leaf packing, which requires the use of the breath,) without the slightest 
difficulty. Six weeks have now elapsed, since the operation was performed, 
and already the space between the teeth is one inch and three lines; the 
tongue is protruded without the slightest difficulty — the patient chews her 
food as well as if she had always been accustomed to do so, and the chin on 
the left side is filling out — the angle of the jaw is of course not very much 
altered as yet; I have no doubt, however, that time will remedy this defect. 
It is well known that in cases of chronic glossitis, tumours of the gums, &c., 
where the angle of ihe jaw either on one or both sides, in consequence of 
the pressure, becomes more obtuse than natural, the original angle, provided 
the cause be removed, will, in a few months, be regained. The same change 
I expect to take place in the case just reported, and in order to hasten it, 
the patient will be requested to use the lever every night, and also to use the 
pluijs of ivory during the day, until il be accomplished. 

Remarks. — Rigidity of the lower j;i\v is a defect occasionally met with, 
and may depend up<m a variety of «'auses. For example, it may be occa- 
sioned by adhesion between the cheek and gums on one or both sides — cica- 
trices from burns, ulcerations, &c., in the vicinity of the mouth — chronic intu- 
mescence of the tongue — permanent contraction of the temporal or masseter 
muscles; the growth of tumours involving the articulations, or some portion 
of the upper or lower maxillary hone; — anchylosis of the temporo-maxillary 
articulations; and finally malformation of the bone itself! Each of ihem 
will of course require a treatment peculiar to itself. 

I have sought diligently, however, to discover a case precisely similar to 
the one reported, relieved by a section of the muscle in fiuill, but have failed 
in so doing, and on this account riiiefly have I presented it to the profession. 

The lever employed in this case after the se<rii«>n of the muscle, is the 
result of the ingenuity of Mr. Rorer surgical Instrument maker, and answers 

Fahnestock's Case of ArtifidalJoint of the Forearm. 


the purpose for which it was designed, 
much better than any other that I have 
seen. — It consists of two parallel plates, 
b, c, so shaped as to fit accurately upon 
the dental arches, each plate being also 
furnished with a superficial gutter on one 
side, in which the teeth rest. This groove 
is of much importance, as it prevents the 
instrument from slipping to one side — the 
parallelism in action of the blades is se- 
cured by the two rods d, d, which pass 
throughthe handle of the upper blade, and 
are attached firmly to that of the ower. In the application of the instrument, 
care should be taken to place the blades- in contact before the screw is 
turned, and they should also be carried as far back as possible so as to rest 
upon the molars. 

This case was seen before the operation, and I believe since, by Prof. 
Horner, and since by Drs. Nancrede, Pettus, and several medical students. 

a Screw. 

c Lower Blade. 

c e Grooves. 

b Upper Blade. 
d d Guides. 

Art. VIII. Case of drtlficialJoint of the Fore-arm. 
TOCK, of Pittsburg, Pa. 

By Dr. P. Fahnes- 

Valentine Wyant, the subject of ihis case, retat. 23 years, is a native of 
Germany, and now resides at Bedford, Pa. On the 11 ih of October, 1836, 
whilst on a hunting excursion, his gun was accidenlly disclinrged, causing 
a compound comminuted fracture of the fore-arm about four inches below 
the elbow joint. About an inch and a half of the substance of ih.e ulna was 
carried away, the radius was obliquely fractured, and the sofi parts were 
extensively lacerated and contused. lie was placed immediately under the 
care of Drs. Watson and Barkely of Bedford, by whom every thing was 
done that skill and science can perform. After a long course of treatment, 
the wound was united, but the injury was only in a measure repaired. 'I'he 
ulna had formed a ligamentous union, whilst the fractured extremities of the 
radius were separated about half an inch, the intervening space being occupied 
by muscular substance. 

The patient first presented himself to me on the 24th of July, 1837. He 
stated that he had consulted various practitioners, the majority of whom 
recommended amputation, to which he was resolved never to submit, whilst 
a few advised him to seek professional aid from the surgeons of Phila- 
delphia. Having determined upon an operation, I invited Drs. Gazzam, 
Addison, M'Dowell and Wright to meet me at 10 (>'clock on the following 
morning. The limb having been examined by three medical gentlemen, 
I commenced the operation by making a longitudinal incision, deep enough 

92 Fahnestock's Case of Arlijicial Joint of the Forearm, 

to expose one of the fractured extremities of the radius, which passed each 
other to a considerable distance. It was found that the lacerated muscular 
substance had united in such a manner around these extremities that they 
were separated to the distance of half an inch. Having removed the inter- 
vening soft parts, the next step of the operation was to bring into view the 
fractured ends of the bone. On depressing the hand and elbow simulta- 
neously the fractured extremity next the hand projected, from which was 
removed by the saw about one inch and a quarter. The other extremity, 
that part next the elbow, was found so deeply imbedded, as to render it neces- 
sary to make a transverse incision in order to be enabled to use upon it 
Hey's saw, and from which was also removed about three quarters of an 

During all this time the hemorrhage was inconsiderable, as the principal 
blood vessels had been destroyed, by the original wound. The arm was 
now dressed as for a compound fracture, the usual splints extending from 
above the elbow to an inch beyond the fingers being applied. As the dis- 
charge soon became profuse, and the weather was warm, it was necessary 
to renew the dressing daily, until the 18th of September, fifty-six days after 
the operation. At this period, it was found that the radius had formed a 
bony union, and the wound had nearly cicatrized. The arm, however, was 
very feeble, owing to a default of support in the ulna, which had originally 
united by ligament. 

I now determined to make an effort to remedy this imperfection and I 
adopted, for that purpose, the mode of operation first proposed and success- 
fully practised by the late Dr. Physick. 

On the 28th day of the following December, I passed a seton needle 
armed with a piece of silk brade through the limb, between the fractured 
ends of the bone. The seton having been suffered to remain between four 
and five months, it was found that perfect ossific union had taken place. It 
was with much difficulty that the seton was removed. 

Since this period, he has suffered a second fracture of the arm at the same 
point. It united, however, by bony union, and he has recovered in a great 
measure the use of the member. The only defect is in the hand and fingers, 
owing to the great destruction of parts by the original injury. Let the patient, 
however, speak for himself. 

Bedford^ January ll//«, 1840. 

Sir: — I have the satisfaction to inform you that ^ver since the operation 
performed by you on my arm which was severely broken by the acci- 
dental discharge of a gun, it has continued to grow better. I am now able 
to use it moderately without pain or difficulty; it is gaining strength every 
day; and the physicians of this place tell me that the bones are completely 
knit, of which I have no doubt from my present feelings compared with the 
pain I suffered before you operated upon it. I will be in Pittsburg in the 
spring, when you can judge for yourself. Yours, Respectfully, 

Valentine Wyant. 

To Dr. p. Fahnestock, Pittsburgh Pa, 

Wharton's Cases of Hemeralo-pia. 93 

Art. IX. — Cases of Hemeralo-pia cured by the Exclusion of Light. By 
W. L. Wharton, Surgeon United States Army. 

Having noticed in a Boston Medical Periodical, the case of a patient af- 
fected with a partial loss of vision during the day, for whose relief it was 
suggested to protect the eyes from the stimulus of tlie sun's rays, I am in- 
duced to state the following ceases of Hemeralopia which were successfully 
treated by the exclusion of light. 

Modern writers have adopted the term Hemeralopia as expressive of night 
blindness, and the discrepancy of opinion which has existed, as to the ap- 
plicability of the words "Nyctalopia" or Hemeralopia to either day or night 
blindness, would appear to have arisen from the Greek etymology of the 
virords, both meaning day blindness. 

It became necessary in the winter of 1834 to concentrate a large military 
force at Fort Mitchell, Alabama. This position is proverbial for its healthi- 
ness. Diseases of a miasmatic origin are unknown tliere. Owing to the 
insufficiency of quarters to accommodate the troops, many of them were 
necessarily encamped. 

February 3, 1834. — Sergeant W. and privates A. and R. of the 2d 
Regiment of Artillery, presented themselves at the hospital tent: had suffered 
partial loss of vision for several nights previously, the defect commencing 
with the decline of day; the last night were affected with total blindness; 
general health good; complained only of a slight uneasiness in the temporal 
regions. The pupils of the eyes much dilated, although not immovable; 
Ordered to the hospital that the eyes might be examined at night, when, the 
blindness returning, the pupils were found more dilated and apparently fixed 
— unaffected by the sudden introduction of a lighted candle into the room. 

15//j. No improvement has resulted from an active resort to general 
and local remedies. Induced to consider the blindness in the first instance 
the effect of debility on the retinae, consequent to a highly excited condi- 
tion thereof, caused by rays of light emanating from large camp-fires, and 
icicles with which the surrounding trees were covered, and protracted by 
the daily impression of light on a part already debilitated. I was led to 
infer that the total exclusion of light would enable the retina to recover its 
tone. I'he patients were accordingly assigned to a room completely dark- 
ened, in which they remained until eight o'clock in the evening. On being 
relieved from their seclusion, it was discovered that vision was in a degree 
restored; the pupils somewhat contracted. Remanded back to the room, 
where they remained until ten o'clock the next night; the sight was entirely 
restored. 18. — Returned to duty. 

Fort Moultrie, Sullivan'' s Island, South Carolina, May 5, 1835. — 

Private D 1st Artillery, entered the hospital: general health good, has 

been in the habit of fishing off" the breakwater, occasionally for some weeks 
past; says that for three or four niijhts previously his vision has been defec- 
tive; last night seized with total blindness, slight pain in the left temporal 
region; pupils in the day much dilated and sensitive, at night are more dila- 
ted and fixed. Abstaining from the use of medicines, he was placed twenty- 
four hours in a room which was darkened, at the expiration of wliich time 
the pupils had recovered their sensibility; vision restored; returned to duty. 

Fort Johnson, Smithville, North Carolina, September 9, 1835.~Pri- 

vate H 1st Artillery entered the hospital afflicted with hemeralopia, 

produced by same cause and attended by similar results, as in the prece» 
ding case. 

94 Sutton's Case of Calculus* 

^ Fort Gibson, Arkansas, February 6, 1839. — Amongst the numerous 
sick of the 4th Infantry, which reached this position, were seven cases of 
hemeralopia. In one case I was informed the disease had existed three 
months, no other case less than two weeks. The men had been on severe 
duty in the mountainous sections of North Carolina, undergoing great fatigue, 
the eyes affected by rays of light reflected from snow. Had received the 
best attention the circumstances of the service would allow. With the ex- 
ception of one case of constitutional scorbutis, the patients were in good 
general health. The pupils of the eyes presented the same appearances as 
in the preceding cases. No medicine was administered; ordered the patients 
into a darkened room, where they remained for thirty-six hours; at the ex- 
piration thereof, the vision of six of the patients was restored, and they re- 
turned to duty. In the case of the scorbutic patient, it required twenty- 
four hours longer to effect a cure. 

Fort Gibson, Cherokee Nation, West, 

Art. X. — Case of Calculus — Enlarged Prostate Gland — Thickened 
and Sacculated B' adder — Bifurcation of the Ureter — Abscesses in the 
Kidneys. By George Sutton, M. D., of Aurora, Indiana, 

From what I can learn of the early history of this case, which is very 
imperfect, Mr. Caldwell, twenty years previous to his death, fell while 
descending a flight of stairs, and received an injury across the small of his 
back; this was followed by violent pain in the lumbar region, which confined 
him to his bed for several months; as the more violent symptoms subsi- 
ded, dysury succeeded connected with vertigo; this last symptom wore oflf 
gradually in a few years, but the dysury continued until complete retention 
of urine took place, and for ten years previous to his death he had to depend 
entirely upon the catheter for the evacuation of his bladder. Occasionally 
he was attacked with the most excruciating pain in the region of the bladder 
and perineum, to allay which he would resort to narcotics in large doses 
until he became so habituated to them, that he considered life intolerable unless 
under their influence. In December, 1838, during a violent attack of his dis- 
ease a small calculus passed into the urethra and lodged about two inches 
from the glans penis. A neighbouring physician was sent for, who made 
an incision through the urethra and renaoved it. After this he was compara- 
tively free from pain for several months. 

In the spring of 1839, Mr. Caldwell came to Aurora to reside. I was shortly 
afterwards called to attend him during a violent attack of one of his paroxysms. 
I found him under the stimulating effects of opium. His pulse about one 
hundred, rather soft; tongue dry and red around the edges; constant and inef- 
fectual desire to pass his urine; tenesmus; most violent pain in the region of 
the bladder and perineum; the pain occasionally passing towards the lumbar 
region; numbness of the thighs; skin hot and dry; his mind very much ex- 
cited. He informed me that he was about seventy years old; that he had 
been subject to these attacks for twenty years; that he was never entirely 
free from pain except while under the influence of opium or morphia; that 
he had been under the treatment of a great number of physicians and some 
of the most eminent in Cincinnati; that no one had ever been able to detect 
the presence of stone in his bladder, but that he had always been confident of 

Sutton's Case of Calculus. 95 

their existence there and the passage of the stone in 1838 confirmed him in 
his opinion. He also staled that about two months since, he had felt another 
stone descending into his urethra and that it had lodged near the neck of the 
bladder, and the symptOFns he now felt were precisely similar to those which 
preceded the expulsion of the stone before. He was very anxious I should 
perform the operation of lithotomy, offering a handsome remuneration. I 
sounded him in several positions but was unable to detect the presence of 
calculi, and considering him to be labouring under a disease of the prostate 
gland and bladder, I prescribed as a palliative the warm bath, anodyne injec- 
tions, mucilaginous drinks, ^i of ol. ricini, followed by the blue pill, (fee. 
The warm bath and anodyne injections speedily produced relief and he be- 
came comparatively free from pain. He frequently called upon me afterwards 
requesting that I would perform the operation of lithotomy on him, and so 
confident was he of the existence of stone in his bladder that he would de- 
clare; "if all the physicians in the world were to tell him to the contrary he 
would not believe them;" and since the passage of the calculus in 1838 the 
only treatment he had been willing to receive, except during the paroxysms, 
was for the direct removal of stone. Finding no person in this neighbourhood 
that would operate for him, he went to Cincinnati for that purpose and placed 
himself under the care of Professor Mussey. The Dr. has since informed me 
that he sounded him carefully and was unable to detect any stone. He told 
him, however, there might be calculi embedded in the coats of the bladder, but 
he considered his case a disease of the bladder and recommended a course 
of treatment accordingly. Our patient remained in Cincinnati about a week, 
and after his return his spirits were entirely prostrated. For eight or nine 
months previous to his death he had borne his sufferings with the hope 
that an operation would produce speedy and permanent relief, but having 
failed in this last resource and finding no one that would operate on him, his 
firmness of character, for which he was remarkable, forsook him, and about a 
week before his death he was seized with diarrhoea which terminated his 

The treatment he had received from the different physicians whom he 
had been under, had been principally for disease of the bladder, but it does 
not appear that any course of treatment had done more than palliate his suf- 

• In presence of a young physician and several of his friends I made the 
following examination. 

Autopsy, eight hours after death. Exterior, unusual emaciation, slight 
rigidity of the upper and lowerextremities. Omentum remarkably contracted, 
scarcely perceptible. Intestines of a dark red colour, very much injected. 
Stomach small and contracted to about two inches in breadth, its internal sur- 
face almost entirely destitute of rugae. It contained about half a gill of viscid 
mucus slightly tinged with bile. The mucous membrane of a dark red 
and abnormal colour throughout, but more particularly near the pylorus, where 
it was softened and in several places ulcerated. Pancreas of a deep orange 
colour, the head of it about the size of a hen's egg and very much indurated, 
it finally adhered by cellular membrane to the stomach and duodenum. Liver 
rather small, healthy with the exception of the right lobe a small portion of 
which was indurated; gall bladdtT inoderately distended with bile and heal- 
thy. Kidneys; the right one small and of a dark pink colour almost as firm 
as cartilage and full of cicatrices; in its superior half was an abscess about the 
size of a pigeon's egg containing a thick whitish pus. The pelvis of the 
kidney was filled with muco-purulent matter, and its mucous membrane as 

96 Sutton's Case of Calculus. 

well as calices and papilla of the kidney were almost entirely destroyed; but 
one or two papillse remaining. The ureter was from half to three quarters 
of an inch in diameter, and greatly thickened; its mucous membrane of a 
deep red colour and in several places ulcerated. About two inches above 
where it passed into the bladder it bifurcated, one branch containing three 
small calculi the largest about the size of a pea, the smallest that of a radish 
seed. These were situated three quarters of an inch apart, and the ureter 
between them was impervious resembling a ligament. The capsula renalis 
was about one-fourtli of its usual size and nearly the consistence of cartilage. 
Left kidney rather smaller than natural, ureter about half an inch in diam- 
eter, and at its upper and lower extremity the mucous membrane of a dark 
red colour, two or three of the papillae were destroyed and the raucous mem- 
brane around them of a deep red. In the body of the kidney there were sev- 
eral large cicatrices and near the upper part was a small abscess about the size 
of a hazel nut filled with a whitish pus. 

The bladder was surrounded by fat and cellular tissue, and almost resembled 
a solid substance, its coats being between half and three quarters of an inch 
in thickness. Its cavity which would scarcely hold half a gill of fluid, con- 
tained a small quantity of muco-purulent matter. Its mucous membrane was 
almost entirely destroyed, having a fibro-cartilaginous appearance. There 
were numerous cells or pockets throughout the parietes of the bladder com- 
municating by small openings with its cavity. Two calculi were found in 
the bladder, one nearly a quarter of an inch in thickness and three-quarters 
of an inch in its longest diameter; the other about half an inch in diameter 
and about a seventh of an inch in thickness. The nucleus of each of these 
calculi were small gravel resembling those found in the ureter; they had be- 
come lodged beneath a protuberance of the prostate gland, and deposition 
of calcarious matter had been formed around them. 'J'hese calculi were found 
precisely where our patient imagined he felt them and it is rather singular, as 
we were unable to detect them by the sound, that he should have been so 
correct in his feelings. The prostate gland resembled a hard scirrhous tu- 
mour and measured in length three inches and a half; its lateral diameter three 
inches, its vertical two inches and three-quarters, the circumference over the 
longest diameterabout nine inches and three-eighths. From the upper part of 
this gland is a protuberance about the size of a walnut projecting into the 
bladder and almost filling its cavity; it is globular and is perforated by a num- 
ber of openings leading to the urethra. 

There are at least ten passai^es to the bladder each large enough to admit 
a common catheter; some of thern passing through the body of the prostate 
gland, but most of them perforating its protuberance. 

The urethra contained a great number of cells or pockets, and was divided 
by tendinous septa which separated the passages to the bladder. These pas- 
sages as well as the cells had evidently been made by the constant use of the 
catheter which was sometimes introduced during the most excruciating pain. 
I have the bladder which I preserved as an interesting specimen of patho- 
logical anatomy. 

The friends being anxious that the examination should be discontinued, 
the thorax and head were not examined. 
March, 1840. 



Art. XL On Dyspepsia, or IndigeMion. By N. Chapman, M. D., Pro- 
fessor of the Theory and Practice of Medicine in the University of 
Pennsylvania. (Continued from No. L, page 341.) 

Dyspepsia by neglect or improper management is prone, as I have said, 
to exchange its primary state of nervous irritation for that of inflammation, 
presenting a new aspect, and requiring a variation of treatment. 

Conversions of this sort, though in most instances slovi^, I have known 
to take place very quickly. Chronic gastritis of a primary character 
having already engaged my attention, I might pass over the secondary 
form of it with a reference only, to what has been p« eviously stated. Con- 
tinuing, however, for a length of time, it may lead to a variety of affections 
of other and remote organs, which, perhaps, have not hitherto received 
sufficient notice, and, among these, that of the lungs is especially inte- 

Connected with the more peculiar and expressive phenomena of gas- 
tritis, there is here an irregular, diminutive fever of a hectic type, with 
suffusions of the cheeks, parched skin, sallowness or duskiness of com- 
plexion, a hard cough, scanty limpid expectoration, heat in the hands 
and feet, pain in the side or breast, and wasting of flesh and strength. 
The case, in short, has so many of the features of incipient catarrhal, or, 
indeed, of tubercular consumption, as to be readily confounded with either 
of these affections. 

An exalted irritation or phlogosis of the stomach, long endured, may 
extend itself to the lungs, arising even from sordes, or worms, or indigestible 
substances swallowed, productive of very serious pulmonary mischief — of 
which examples are of no unfrequent occurrence. 

As long ago as 1805, I was consulted by a young woman with cough, 
purulent expectoration, hectic fever, and the other phenomena of appa- 
rently confirmed phthisis. Being satisfied from the appearance of the 
tongue, constipation of the bowels, the nature of the discharges when pro- 
cured, and other phenomena, that the pulmonary symptoms depended on 
a primary disorder of the alimentary canal, I instituted a practice accord- 
ingly, and on the restoration of its healthy functions, the secondary disease 
entirely disappeared. 

In 1820, I was called into consultation with the late Dr. Monges to a 
boy, who, with most of the symptoms of the preceding case, particularly 
the copiousness of purulent expectoration, was so much reduced, as that 
the portions of the bones on which he rested had protruded through the 
integuments in several places. Discovering that his abdomen was tumid, 
his tongue furred, his appetite capricious and depraved, and that he was 
subject occasionally to convulsions, I was led to suspect the existence of 
worms, and, under such an impression, anthelmintics were administered 
No. LI.— iMay, 1840. 9 

98 Monograph, 

In less than one week, sixty-eight lumbricoides were evacuated, and from 
that moment he became convalescent, and rapidly got well. 

We learn from Hildanus, that a woman, having swallowed a metallic 
button, was soon attacked by pulmonary irritation, which eventuated in 
purulent expectoration, &c. The button, however, was finally vomited up, 
and she speedily recovered. Much such cases are recorded by Bartholini, 
occasioned by the ingurgitation by a boy of a swine's tooth, and by Per- 
cival, from a nutmeg in the stomach of a girl. Dumeril has more recently 
noticed another, very analogous, induced by a nut shell retained in the 
stomach for some length of time. 

Do we not know, in further illustration of the same principle, that sto- 
mach coughs, so denominated, are very common, and that cynanche 
trachealis, asthma, and angina pectoris, may be brought on by certain 
intractable ingesta? Croup, especially, I have several times seen occasioned 
in children by gastric repletion: and twice by worms, of which, other in- 
stances are noticed by the late Professor Barton, and in the foreign journals. 

Mostly, in instances of a chronic nature, the irritation of the raucous 
membrane of the stomach is extended only to that of the lungs inducing 
chronic catarrh or bronchitis. But where the tubercular diathesis exists, 
real phthisis may be developed. 

Further, by the play of sympathies, other structures become involved, 
and particularly the duodenum, the liver, spleen, pancreas, all of which 
have been found highly affected, displaying phenomena, separately or 
mingled, with those of the stomach. It is an interesting fact, that some- 
times a secondary affection is ultimately more violent in its character, and 
destructive in its consequences, than the one from which it is borrowed. 
7'his is strikingly exemplified in the history of the disorders of the chylo- 
poietic viscera, and above all, as regards the liver, it suffering more than the 
stomach. By virtue of a law of the animal economy, the primary is 
usually aggravated by the secondary lesion, till the latter from an in- 
crease of vehemence acquires an ascendancy when the former begins to 
abate, and may be entirely supplanted and cured. 

Cases, however, of this description, obviously have no claims to present 
consideration — a new disease, in a different part, being produped by this 
assumption. To the enduring morbid condition of the stomach, our at- 
tention is to be limited, as the root still sustaining the progeny from it, 
which, being eradicated, the latter of necessity perish. In relation to these 
and all other sympathetic afl^ections, this is a distinction to be observed, as 
a guide to practice. Having, however, already treated of the idiopathic 
states of gastritis, I must be content by a reference to what has been said, 
and proceed to present another view of the subject. 

It happens, as we have seen, that in the commencement of dyspepsia, 
there is often a great preponderance of nervous irritation, constituting what 
I suspect is termed the irritable or sensitive stomach, which sometimes 
endures for a considerable period. This, without passing into phlogosis, 
or its other more ordinary terminations, may run into the chronic state and 
then is entitled gastralgia, in contradistinction to chronic gastritis. 

Let me explain this point a little further. Inflammation is a compli- 
cated process, consisting of three stages, of which the first is nervous irri- 
tation, and the next congestion. But it does not uniformly observe so 
regular a course, and may especially, be arrested in the beginning when 
simply irritation prevails, which, like inflammation, becomes protracted, 

Chapman on Dyspepsia. 99 

with some alteration of character. In this sense it is that gastralgia should 
be understood, or in other words, as a lingering painful irritation of the 
nerves of the stomach, independent of phlogosis. Great care has lately 
been taken to establish a diagnosis between these two conditions, and a 
summary of the distinctive features I formerly presented. 

As of a purely neuralgic nature, I shall hereafter expatiate on this affec- 
tion in the different stages, when I reach the general consideration of the 
subject. Enough at present, therefore, may it be to mention that, at first, or 
while extreme irritability or sensibility prevails, of internal remedies the 
most emollient and soothing are to be employed in conjunction with the 
external topical means already indicated, and when the acuteness of sen- 
sibility is somewhat appeased, the prussic acid, the nitrate of silver, the 
sulphate and oxide of zinc, the acetate of lead, the sulphate of quinine, the 
preparations of steel, alone or with the opiates or henbane, have consider- 
able reputation, and are the most efficient means of cure. The prepara- 
tions of strichnine, also, have recently been much commended, though I am 
much inclined to suspect, from what I have seen of their effects, more from 
theory than any positive evidence of their efficacy. 

Next, I am to advert to some secondary dyspeptic affections of the 
stomach, arising from the sympathies of that organ. with other parts of the 
system previously diseased. 

Deeply interesting, however, as the subject is, it were now out of place 
to enter into any details as to the pathological states productive of such 
effects, the examination of them not appertaining to my immediate inquiry — 
and, for a similar reason, I shall now merely remark in relation to the cure 
of the gastric disorder, that it being dependent in its nature, it can only be 
overcome by the restoration of the organ whence it may be derived to its 
healthy condition. The same course is to be pursued in relation to any 
other special cause of the affection, such for example, as hemorrhoidal 
tumours, it being essential to the cure to remove the direct source of irritation. 

As my knowledge, however, .increases of dyspepsia, the more am I 
satisfied that, as a secondary affection, it is rarer than perhaps is commonly 
imagined. Cases so supposed to originate, I believe, are consequent 
mosdy on original gastric irritation, the lesion of the stomach being lost 
sight of in the subsequent more violent and permanent derangements of 
other parts. 

Let it be recollected, how much that viscus is troubled by the abuse of 
medicines, and from the introduction into it of every variety of substance, 
which the wants or caprices of appetite solicit, not to cite other causes, — 
and the peculiar liability of the intestines, the liver, the spleen, the pan- 
creas, the uterus, the brain, and indeed, every other structure, to partici- 
pate in its sufferings, we can hardly resist the conclusion. Yet these 
organs, thus aggrieved by the stomach, return on some occasions in a spirit 
of retributive justice, the injury, they receive from it, with the severest 

To bring this discussion to a close, it only remains to consider the regi- 
men appropriate to dyspepsia. No part of the investigation is more im- 
portant, and hence, in treating of it, 1 shall enumerate all those particulars 
required in the delivery of precise and definite instructions regarding it. 
LitUe will our remedies avail, unless aided by a regulated diet, and a pro- 
per attention to some other circumstances of the regimen. 

The stomach being the immediate seat of the lesion, and the recep- 

100 Monograph. 

tacle of food, nothing, surely, need further be said on the importance of 
selecting such nutriment as shall be the least offensive to it, and which 
demands the slightest exercise of its functions in so crippled a condition. It 
is not, however, true, that the most digestible articles are always the most 
proper as is commonly supposed. The contrary sometimes happens, or 
the blandest, though less tractable to the powers of the stomach, are better 
suited. Thus, among other examples, the mucilages, from their inirritative 
qualities, may be singularly appropriate, slow and difficult of digestion, as 
they are proved to be. But, inasmuch, as dyspepsia in its progress, varies, 
the diet must be accommodated accordingly. 

We are first to notice what is adapted to the earliest stage of the dis- 
ease, where extreme nervous irritation prevails, with an intolerance of ali- 
ment, except the very mildest. Little else will be endured here, than 
barley or rice water, or rennet whey, or thin gruel, sago, and such like 
articles. Cases of this sort, however, are rare, and when they do occur, 
may be soon brought to bear a more substantial diet. Then, for the morn- 
ing, and evening meals, milk is to be preferred. 

It will itself often cure cases, which have proved very obstinate. But 
it is sometimes required, that the patient live solely upon it, not having 
even bread allowed him. Milk is applicable to nearly all the varieties of 
dyspepsia, and its complications. It relieves gastrodynia, pyrosis, cardi- 
algia, and palpitations. But it is objected to it, that it disagrees with 
many persons. That there are idiosyncrasies, forbidding its use, is very 
conceivable — though I have seldom met with such instances. It may be 
puked up and turned, which ought not, as is generally thought, to discourage 
us from further trials. The first step in the digestion of such fluids is 
coagulation. What, on the whole, was said long ago, by Cadogan, is 
nearly true; — that milk is most proper, when it appears least suitable — 
having the power of correcting the morbid states of the stomach, and 
hence, remedial in its preliminary effects. Nevertheless, it may be inad- 
missible, especially when it accumulates in large masses of a cheesy- 
nature, productive of gastric oppression, or unrelenting obstruction of the 
bowels, with the alarming consequences of such conditions. 

Three very remarkable instances of the kind, I have met w^ith. Not 
many years ago, I had brought to me a mass, which in length, breadth, 
lobulated structure, and general aspect, so closely resembled the pancreas, 
that it might, at a glance, have been mistaken for that organ. On tearing 
off a part of the integument, which was a coating of coagulable lymph, I 
found the interior to consist of compact cheesy matter. As an explanation 
of the phenomenon, it was stated by Dr. Tydiman my informer, that several 
months before, on a journey from South Carolina, his coachman in 
whom it occurred, drinking copiously of milk, was soon after seized with 
colic, which though relieved, so many of the symptoms of hepatitis occurred 
that the case was treated under such an impression. By a violent effort 
of vomiting, the mass was brought up — convalescence commenced, and 
an entire recovery ultimately took place. The preparation is in the museum 
of the Pennsylvania University. 

Not long afterwards I saw, with Dr.Physick, a lady, who for the cure of 
dyspepsia, went to the country, where she lived for upwards of three weeks 
entirely on milk. Constipation speedily ensued, which gradually increased 
till it became utterly unrelenting, and she was brought to the city with an 
enormous distension of the abdomen, and as much pain as in the severest 

Chapman on Dyspepsia, 101 

labour. By a scoop I removed an immense mass of cheesy matter from 
the rectum, and subsequently by enemata and purges it continued to pass 
away till the aggregate amounted to six or eight pounds — as we conjec- 

More recently I was called to a little girl of four years of age — in very 
much the same situation, who had been placed for some time on a strict 
milk diet. Being told that an enema could not be administered from an 
insuperable impediment to the introduction of the pipe of the syringe, I 
made an examination, and discovered the rectum loaded with the same sort 
of cheesy matter, of which I am sure, more than a pound must have ulti- 
mately escaped. Examples very similar have been reported by Bartholini, 
Elliotson and other writers. 

As a substitute for milk where it, for any reason, cannot be taken, cocoa 
may be directed, or chocolate, prepared with boiling water, which is to be 
permitted to become cold, then to skim off the oily and feculent matter, 
collected on the surface, re-boiled and poured on cream and sugar. Even 
better than this, perhaps, is a very light and agreeable preparation of the 
article vended in this city also under the title of dyspeptic chocolate. 
Disgusted with these articles, the patient may take black tea. Coffee and 
green tea should rarely be admitted. 

The articles for dinner, are game, or white poultry, or beef or mutton. 
Nor veal, nor lamb, nor geese, nor ducks, nor fish, are proper. The first 
two of these prohibited articles are objectionable, from the well ascertained 
fact, that all young meats, owing to their fibrous and stringy texture, are 
less digestible, and the rest on account of their grossness, or otherwise 
offensiveness to the stomach.' 

Every variety of soup is pernicious, as liable to sour. The essence 
of beef, however, is allowable, and where the stomach has lost its tone, 
we direct a modicum of salted or smoked meats, thoroughly boiled, which 
are particularly useful in the weakened stomachs of inebriates. The same 
may be said of some of the condiments, as Cayenne pepper and mustard. 

Little vegetable matter should be taken, the best of which is rice, or 
the roasted potato. There are, however, some exceptions to this rule. 
Cases occur where a vegetable seems to answer better than an animal diet. 
But such are exceedingly rare. Leaven bread stale, and without butter, is 
to be preferred. Crackers, usually directed, are apt to oppress. Bran 
bread, as it is called, made of unbolted flour, is sometimes useful, particu- 
larly by keeping the bowels open. It seems, however to operate mechani- 
cally, by the irritation Cf its indigestible husks, and should, therefore, be 
withheld, whenever there is the least phlogosis or increased sensibility, in 
the primae viae. Great injury I have seen from the too indiscriminate 
use of this article, which is not certainly always, as is pretty generally 
supposed, in the doggerel rhyme of an old poet, 

" The household bread, 

Curative of the aching- head, 

And constipation's other ills, 

For which folks swallow salt and pills." 

Cakes, as well as toast, either dry or otherwise, as usually prepared, 
are improper. To the former there may be, perhaps, a single exception. 
Cases I have met with among our southern and western people, with 
whom the cake made of the Indian meal agreed better than wheaten bread, 


102 Monograph. 

probably from their being more habituated to it. As to dry toast, I wish 
to be explicit, since an opinion ahnost universally prevails opposed to the 
one I have expressed. But there is little doubt of my being right. Gene- 
rally, the slice is thick, and very imperfectly toasted, in which state it is 
so disposed to fermentation, that in a {ew minutes it becomes sour to the 
smell and to the taste. Better made, it may be wholesome. Even this, 
or bread in any shape, is sometimes inadmissible. 

Nearly every species of dessert is detrimental, including fruits, nuts, &c. 
Yet I have known ice creams beneficial, or at least harmless, taken in the 
intervals of the regular meals. 

The stomach has been pronounced by a very sagacious observer. Sir 
William Temple, to be, in one respect, like the schoolboy, always doing 
mischief when not employed. This short aphorism contains a vast deal 
of practical wisdom in relation to dyspepsia. By eating often, while the 
system is adequately nourished, the stomach escapes oppression. To 
this very general rule, there may be occasionally an exception. The 
stomach being irritable, or too much fatigued, to perform its functions, an 
entire intermission of ft)od, for a longer time, may enable it to recruit its 
energies, as is illustrated in the effect of rest on some other organs. We 
have here an instance, where " all work and no play" may not answer. 

It is known to me, that the propriety of the precept I have cited, and 
endeavoured to enforce, has been contested. By eating frequently, it 
is said, chymification and chylification, which follow each other in suc- 
cession, are int.erfered with, and that such an interval should be allowed 
between taking food, as to enable the first of these processes to be com- 
pleted before the second commences. But>the allegation is preferred on 
false premises. From the most authoritative experiments, it appears that 
these two operations are simultaneously performed, or as quickly as chyme 
is prepared, it passes into the duodenum, to make way for a fresh layer of 
food to come in contact with the sides of the stomach, as well as to be 
more exposed to the action of the gastric juice. 

Greater force exists in the objection, that by this practice the habit of 
the stomach is interrupted, and from so wide a deviation mischief must 
ensue. But we are not speaking of the sound condition or the usages of 
this organ under such circumstances. Dyspepsia deranges every thing 
connected with the functions of the stomach, and we are called to view it 
thus diseased rather than physiologically. Not now to decide pe- 
remptorily on the effect of more frequent meals than society has esta- 
blished, 1 will only ask, how can adequate replenishments of aliment be 
attained, in this case, except by such repetitions of it as I have proposed 
where no large quantity is admissible at once? 

Be it as it may, however, the amount of food must be small. Error in 
quantity in this respect is, perhaps, even of more importance than error 
of quality. It has been well remarked, that " the weakest stomach may 
digest a little of any thing, and the strongest rmich of nothing." As to the 
sum of solid animal food to be allowed, this must be accommodated to the 
circumstances of the case. Not more than an ounce will be borne by some 
stomachs at a time, while in other instances several ounces may be tole- 
rated. The best rule as to quantity, as well as quality, is the absence of 
all uneasiness. Consciousness of any thing in the stomach, affords evi- 
dence of its disagreeing. Digestion, when salutary, diffuses argreeable 
impressions over the system, without any positive sensation in the stomach 

Chapman on Dyspepsia. 103 

itself. But we cannot always trust this matter to the patient himself. 
Definite instructions are then to be given to the attendant, and to attain 
absolute precision, in certain delicate cases, the food should be weighed. 

It is a predominant opinion, that eating in the evening is very prejudi- 
cial, and hence prohibited. No doubt the digestive energies, in common 
with those of all the great functions, are impaired at this period. The 
system is worn down, and seeks repose as the natural restorative. Con- 
curring in the general denunciation of suppers, I must still insist that the 
rule excluding food altogether, cannot unexceptionably be received. Cases 
I have seen where exhaustion was considerable, the stomach without tone, 
and annoyed by the harassing sensations of emptiness, with nervousness 
and morbid vigilance, that were relieved by a little food at bedtime, and 
even at a later hour, when such a state of wretchedness came on. 

As to diet, however, some more precise directions are demanded. 

1. Do not mix the food, since, exactly as it is simple, so is the facility 
of digestion, and the absence of uncomfortable consequences. That a 
contrary doctrine, deduced from some experiments, is maintained, I am 
aware. But these were made on a healthy stomach, and whether true or 
false in that relation, the fact is unquestionably otherwise as to the disor- 
dered state of the viscus. 

2. Chew the food well, and slowly, that it may be thoroughly imbued 
with saliva, on which account it is better to take it in large pieces than 
mince it, except mastication cannot be performed from the want of teeth. 
It has been said that the x\merican people are remarkable for the rapidity 
with which they eat, and some ascribe the prevalence of dyspepsia among 
us, in no slight degree, to this cause. No one doubts that the bolting of 
food is pernicious. 

3. Drink moderately at meals. They who indulge freely, or abstain 
entirely, err alike in this respect, as a certain degree of fluid is promotive 
of dii^esiion. The celebrated Mr. Abernethy differs from me in some 
degree on this point. He thinks that no fluid should be allowed while 
eating. Being questioned as to the regulation of diet by a female friend 
of mine, witli his usual oddity, he replied to her: "Live, madam, as a 
cow — eat your food — take a drink afterwards — lie down> and go to sleep. 
Did you ever know a cow to have dyspepsia?" 

4. Exercise is not to be taken for an hour or two following a repast. 
We should rest, though not sleep — the one state advancing, and the other 
retarding the digestive process. 

5. Nor is it less important to postpone eating after exercise where it 
has been considerable. This, though it may sharpen appetite and perhaps 
invigorate digestion in the robust, has a contrary tendency in the valetu- 
dinary — the stomach, under such circumstances, pretty uniformly sharing 
in the general enervation from fatigue. 

6. But, above all, take care that the food be well cooked. More im- 
portant is this than the nature of the article itself. There is scarcely any 
thing which may not be so prepared as to render it digestible — and, con- 
versely, by negligence or the want of skill, every thing may become per- 
nicious. The predominant taste in this country, derived from our ances- 
tors, the British, prefers imperfectly dressed food. Bloody effusions may 
be constantly seen to issue from fresh meat on our tables, when carved^ 
the sailed and smoked are served up dry and hard, and vegetables loo raw. 
But, what is worse, it is intentionally so, since in this state, while food is 

104 Monograph. 

deemed more palatable, it is believed to be also more wholesome. Now 
the great purpose of cooking is to perform that for which the teeth are 
designed, or to co-operate with them in breaking down the texture of food, 
so as to make it easier of reduction to a pulp by the powers of the stomach, 
and to accomplish which, it must be thoroughly dressed. Boiling or stew- 
ing, particularly the latter, is most effectual to this end, though in broiling 
or roasting, a greater amount of the juices of meat is retained — at the same 
time it is more savory and nutritious, and may be made very tender. The 
worst of all modes is frying, from the impregnation of the meat with ex- 
traneous oils, the whole becoming empyreumatic, and the meat tough. 

The appetite being sometimes feeble, it is necessary to excite it. With 
this view — 

1. Keep from the patient the knowledge of what he is to eat, and sur- 
prise him with something inviting. 

2. Do not disgust him by the smell of meat. To avoid this it may be 
cold, and which indeed is usually preferable. 

3. The dishes should be small. It often happens that we shall eat with 
avidity of a nice little bit, when we would loathingly reject a large joint 
of meat. 

*4. The food ought to be frequently changed. 

" Occidit miseros crambe repetita." 


" The same stale viands, served up o'er and o'er, 
The stomach nauseates." Wynne. 

This occasional variation renders it more attractive, and at the same time, 
promotes digestion. Confined to one article, however wholesome, the 
stomach will soon languish and fail to derive nutriment from its suffer- 
ings like the lungs, from the continued inhalation of the same air, the 
respiratory process under such circumstances becoming uniformly less 
actively performed.* 

5. As of the last importance, the mind should be preserved tranquil and 
happy at the moment of the meal. Disturbed by anxiety, fretfulness, 
anger, or any painful emotion, even the reception of unple^asant intelligence, 
the inclination to eat, at once ceases. By the Poet of nature, this was un- 
derstood, and well expressed. 

" Read o'er this: 

And after this, and then to breakfast 
With what appetite you have." 

Of drinks, I believe, on the whole, water is best. Malt liquor, either 
sound old porter or ale sometimes answers, though it more frequently dis- 
agrees. Wine, however pure, is for the most part pernicious, generating 
acidity, which induces irritation. Exceptions, however, are occasionally 
to be met with, in states of extreme atony of stomach, and general wretch- 
edness, and where it seems to be instinctively called for, it proves cor- 
dial, and may be even more permanently useful. It is to such that St. 
Paul's advice to his friend Timothy is just, as well as kind, " to drink a 

* Johnson on Dyspepsia. 

Chapman on Dyspepsia, 105 

little wine for thy stomach's sake, and thy other infirmities." Most of the 
highest authorities concur with the Aposlle, and from which I cannot dis- 
sent. The best wine is Sherry or Madeira. Port, which from its tonic 
properties, is occasionally recommended, constipates and proves otherwise 
pernicious. Weak old brandy or whiskey and water are also beneficial 
under like circumstances, and the previous habit of using them, having 
prevailed, they must be conceded. But whatever is granted let it be spa- 
ringly. Deluging the stomach defeats all our purposes, by diluting the 
gastric liquor, and so distending the viscus as to prevent its contractions, 
thus weakening or destroying the agencies, by which, the digestive pro- 
cess is executed. 

As detailed, such are the leading precepts to be observed in the dietetic 
management of genuine dyspepsia. Not the least cause of perplexity in 
regard to their just application arises from the apparent similarity of cases, 
dependent on different conditions of the stomach. 

Thus, among other instances, whenever that organ is irritable, it exhibits 
so many of the phenomena of phlogosis, that the two stales may be con- 
founded. Now irritability may be owing either to inflammatory excite- 
ment, or total absence of it, extreme weakness, and as the one or the 
other state prevails, so must the diet be adapted, in the former to consist of 
bland fluids only, and in the latter, particularly when of a gastralgic 
nature, of solids as exclusively. Blunders, on this point have been re- 
peatedly witnessed by me, and where on an exchange of a mild, and 
sparing mucilaginous, for a nutritious animal diet, or the converse, accord- 
ing to circumstances, very salutary results took place. 

Constantly, have we, reports of the most discrepant sorts of nourish- 
ment agreeing with dyspeptics — partly to be referred to individual idiosyn- 
crasies, though, certainly much mofe to the pathological state of the case. 
Even of some remarkable cures I have heard, by a free indulgence in sour 
beer, raw turnips, raw cabbage, or fruit. Three such extraordinary cases 
came within my own knowledge, which were speedily relieved, the first, 
by living exclusively on the morilla cherry, the second on fresh roasted 
pork, and the third, on mush made of wheaten flour, with vinegar, to which 
the persons were driven by an irresistible instinctive propensity. 

It has occurred to me, from observing these singular efi'ects, that some- 
times, the least digestible articles might rapidly operate beneficially by 
setting up a new action subversive of that on which dyspepsia depends. 
This is the modus operandi of many of our medicines, particularly the 
stimulants and tonics, and why should not alimentary substances, equally 
intractable to the resources of the stomach, occasion similar results. The 
conjecture, however, is thrown out more as an explanation of the anomaly, 
than as a suggestion to be carried into practice. 

Nevertheless, some regard should be paid, in the regulation of diet, to 
the taste, habits, longings, and other peculiarities of persons, as well as to 
their own experience, as to what agrees best with them, though at the 
same time, we must be careful not to be led astray by the force of their 
propensities. The common adage, that every man of forty, who is not a 
fool, becomes, in this respect, his best physician, is not true. They very 
often deceive themselves, and impose on us, by the lusts of appetite, or by 
a repugnance to submit to our discipline. What drunkard, for instance, 
would not declare that whiskey agreed with him, and where is the gour- 
mand, that does not sigh at the loss of his ample meal? 

106 Monograph, 

National tastes, to a certain extent, are likewise to be consulted. Thus 
a Frenchman would turn with disgust from an article, which delights the 
palate of an Englishman, or reversely — and the same sort of predilections 
and aversions, are found among the natives of different sections of our own 
country. The Virginian doats on his bacon and greens — the Yankee on 
his codfish and potatoes — and the Pennsylvanian on his sour crout and 
goose, each, perhaps, wondering at the singular preference of the other for 
such dishes. 

To yield to a certain extent to the likings and dislikings of the patient, 
I say, may be proper. The food at which the palate revolts, cannot fail to 
be ill received by the stomach, and probably prove very offensive to it, — 
while, on the contrary, what is eagerly solicited or relished, may be cor- 
dial and invigorating to the digestive powers. 

Concluding this portion of our subject, I wish it to be distinctly under- 
stood, that the dietetic precepts which have been delivered, are not abso- 
lute, or of universal applicability. Not more diversified, scarcely is man- 
kind in the expression of countenance, than in constitutional modifications. 
The term salutary, or otherwise, in regard to his nourishment, is relative, 
in a degree, and experience abundantly teaches, that an article very harm- 
less to one, may be to others directly the reverse. "To assert," says on old 
writer (Van Swieten), "a thing to be w^holesome without a knowledge of 
the person for whom it is intended, is like a sailor, pronouncing the wind 
to be fair, without knowing to what port the vessel is bound." My 
object has been to generalise in framing this set of instructions, and to the 
discrimination of those for whom they are intended, must I confide the 
accommodation of them to special exceptions. 

In some of the more obstinate forms of dyspepsia, much advantage is 
derived from remedies addressed to the system generally. The warm 
bath, taken twice or thrice a week, is useful, and so has the cold bath 
proved in other states of the disease. On the same principle, frictions 
especially with fine salt, over the entire surface are serviceable. The skin, 
in the protracted cases of dyspepsia, is dry, and with a very feeble circu- 
lation. Whatever, then, is calculated to reinstate its healthy functions must 
not be overlooked. 

Exercise is so highly useful, and above all, riding on horseback, that it 
may itself cure the disease. My remarks, of course, apply to the atonic 
dyspepsia. Under other circumstances, rest and quietude, till the phlo- 
gistic diathesis is overcome, is scrupulously to be observed. 

Too little attention is here commonly paid to clothing. No fact is better 
established than that of the reciprocal and most intimate consent between 
the cutaneous surface and the alimentary canal. Warmth of the skin ought 
hence to be maintained — and for this purpose, flannel is to be worn at all 
seasons. We are aware of its utility in the bowel complaints, and it is 
not less so in those of the stomach. Extreme sensibility to cold existing, 
direct a waistcoat and drawers of buckskin. 

I have previously remarked how apt cold feet are to induce dyspepsia. 
With the slightest predisposition, they seldom fail to excite, or, if it ex- 
ists, to exasperate, the disease. As precautionary, worsted stockings with 
buckskin socks should be worn, and something irritating, as Cayenne 
pepper, may be applied to the soles of the feet. This is both a preventive 
and curative expedient, and particularly of the sympathetic afiections of 
the head, as cephalalgia, and also of depraved vision. Even a case of 

Chapman on Dyspepsia. 107 

incipient gntta serena I have have known to be cured by irritations con- 
stantly kept up on the soles the feet. 

It should not escape notice, that the want of sleep and inquietude at 
niiijht is among the most uniform and harassing incidents of the disease, 
exhausting strength and exasperating the nervous derangements. The 
use of opiates is objectionable from their constipating efl'ects, though the 
acetate of morphia, endermically applied, sometimes succeeds very well. 
Nervines of every description, such as camphor, the oil of valerian, Hoff- 
man's anodyne liquor, are resorted to, though for the most part unavailingly, 
and are pernicious to the stomach. The most certain relief is afforded by 
rising in the morning early, taking exercise during the day, a stimulating 
pediluvium on going to bed, and very frequently by a dose of the super- 
carbonaie of soda, or of ley prepared as formerly mentioned. 

In the event of other measures failing to cure dyspepsia, a trial of some 
of the waters of our mineral springs should be made. 

Those of the best repuie are of New York, Pennsylvania and Virginia. 
Many are the instances of their beneficial and even restorative effects. 
Excellent as they all are, the latter, however, are preferable, as well from 
superiority of climate, as the greater diversity of qualities. Embosomed 
in a mountainous region, where the heats of summer never penetrate, and 
from which the diseases of the season are excluded, there is, within a 
very limited space, a group of some ten or fifteen of these waters of de- 
cided activity, including natural baths of every gradation of lemperature 
and difference of medication. Not a little is to be ascribed to their medi- 
cal properties, though, in a just appreciation of them, we must also include 
the advantages of the change of scene, a purer air, a more cheerful society, 
and the interruption of pernicious habits and associations. It is in these 
modes that a long journey over a delightful district of country, or a visit 
to a European metropolis, or a residence in some of the genial climates of 
that section of the world proves so efl^ectual. 

The preceding observations plainly relate to the reduced shapes of the 
disease. Excitements, on the contrary, are to be abstained from, under 
other circumstances of dyspepsia, and I am quite sure, from my own ex- 
perience, that every description of mineral water is prejudicial and inap- 
propriate. Ever doing good in the active state of the disease, of which 
we hear occasionally, it is by the revulsion created on the bowels, the kid- 
neys, or skin or some other emunctory — a principle too uncertain, as well 
as dangerous in its tendencies, ever to be hazarded, or, at least, adopted as 
a rule in the treatment of such cases. 

But what will all I have said accomplish, unless the remote and exciting 
causes of the disease be carefully avoided. Let it, therefore, be impera- 
tively inculcated on a patient, that he is altogether to renounce those habits 
and pursuits which, directly or indirectly, may have contributed to the 
production or maintenance of his case. If he be intemperate, he is to 
become sober: if he uses tobacco, opium, or any other baneful article, he 
is to relinquish it: if he be luxurious, he must institute a reform in his 
scheme of living: if he be indolent, he should be awakened to enterprise: 
if he be studious, he is to abandon the midnight lamp: if he be afflicted, 
we must soothe his misfortunes by holding out to him the promises of hope 
and the gilded prospects of the future. 

These cases are often very troublesome, and trying to the patience of a 
practitioner, from the great predominance of hypochondriasm. Exceed- 

108 Monograph. 

ingly querulous, from the very nature of the disease, the dyspeptic is eter- 
nally complaining of the most preposterous feelings, and is apt, after a 
time, to exhaust our benevolence and sympathy. But this is wrong. 
Whatever may be the extravagance of his conceits, they arise from the 
intimate dependence of our moral nature on our physical constitution — and 
being the result of diseased action, become legitimate objects of medical 
care. Treat him therefore kindly, and even with tenderness. Encourage 
him, to the last, with the expectations of cure— and never, on this or any 
other occasion, should a patient be consigned to the horrors of despair. 

" Sunt verba et voces, quibus hunc lenire dolorem, 
Possis et magnani morbi depcnere partem." 


" The power of words, and soothing sounds appease 
The raging pain, and lessen the disease." 




Art. XII. — Medical Institutions, Diseases, ^^c, at Athens and Consian- 
tinople. By Pliny Earle, M. D. . 

Greece has so recently been released from the bondageof the Ottoman, 
her present government has been of so short duration, and her people, as a 
body have hitherto made so little progress in civilization, that no one can 
reasonably expect to find her institutions for the promotion of medical 
knowledge, or for the treatment of disease, either so numerous c- under 
so thorough discipline as those of the United States, or of the nations of 
Western Europe. Tlie only medical school in Greece is at Athens; it is 
a department of the University in that city. It was established six or 
seven years since, at the time of the adoption, by government, of a system 
of general education for the people. The faculty consists of seven pro- 
fessors, and the several branches of the science are divided among them as 
follows, viz: 1. Special Pathology, Special Therapeutics and Clinical In- 
struction; 2. General Pathology, General Therapeutics, and ihe History of 
Medicine; 3. Anatomy and Physiology; 4. Operative Surgery; 5. Gene- 
ral Surgery; 6 Obstetrics and Materia Medica; 7. Public Hygiene. 

The professor of Operative Surgery is a German; the rest of the faculty 
are, I believe without exception, natives of Greece, who have mostly been 
educated in the schools of either Germany or France. A medical society 
incli'iding among its members the Professors of the medical school, the 
physician to the king, and several other practitioners in the city, holds a 
meeting, once a week, in the basement story of the University. The usual 
exercises consist in the reading of an original essay, upon some branch of 
the science, discussion thereupon, and verbal reports of important or inter- 
esting cases which may have occurred in the practice of any of the mem- 

The Military Hospital which was erected about three years since is the 
laro^est building in Athens. It is about 150 feet in length, and constructed 
of ialocks of unhewn sione. It is situated on the south eastern side of the 
Acropolis, in the vicinity of the ruins of the arch of Adrian and the temple 
of Jupiter Olympus. Its accommodations are sufficiently extensive for 
200 patients; there were, however, but about 70 under treatment in De- 
cember, 1838. It contains five commodious wards for soldiers, two smaller 
ones for officers and one foj* the servants in the royal palace. The 
bedsteads are of iron; the mattresses, .straw and hair. A board at the 
head of each bed contains the statistics in relation to the patient, under the 
following heads; 1. The regiment to which he belongs; 2. The place at 
which he is stationed; 3. His name; 4. Native country; 5. Religion, 6. 
Age; 7. Disease; 8. Regimen. 

The officers and soldiers of the national troops receive the benefit of this 

No. LI.— May, 1840. 10 

1 10 Medical Education and Institutions. 

gratuitously. Citizens are admitted upon a charge of two drachmas, or about 
thirty three cents, per day. Hence the hospital is not exclusively mili- 
tary. The kiichen and the pharmacy, the latter of which contains an 
ample assortment of medicines, are disconnected from the principal edifice 
and situated in its rear. A room adjacent to the pharmacy is devoted to 
dissections and autopsic investigation. An anatomical and pathological 
museum has been commenced, and, considering the brief period which 
has elapsed since the Hospital went into operation, the collection is exten- 
sive. Among the instruments belonging to the institution there is one in- 
tended as a substitute for the chain gaw. Indeed, it is that instrument 
combined with and operated by a cotnplication of machinery. It is inge- 
nious in design and is a beautiful specimen of the mechanic art, but in 
most cases the simple saw would be preferable in practice. The instru- 
ment was invented by Heyne a surgeon of Germany. 

I formed while in Athens a valuable acquaintance in Dr. Roezer, the 
physician to the king. He is a Bavarian by birth, but was educated in the 
German and French Institutions. Although quite a young man he speaks 
the German, English, French, Italian and Greek languages with fluency, 
and his professional acquirements are very extensive. 

He invited me to spend every morning with him until the hour at which 
he commenced his visit to patients in the city. Accordingly I called seve- 
ral times. Immediately upon my arrival, each morning, the servant, ac- 
cording to the custom of the East, brought in coffee, pipes, and tobacco. 
The pipes were of Turkish make, having mouth-pieces of amber, and 
wooden stems several feet in length. The Doctor holds a consultation at 
his office during an hour, every day, at which he sees a large number of 

Diseases of the portal circle, congestions, inflammations, and organic 
lesions of the liver are very prevalent at Athens. Diarrhoea, at all times 
frequent, sometimes assumes an epidemic character, rages with severity, 
and occasionally with extensive fatality. A short time previously to my 
being at Athens, an epidemic of this kind had carried off a large number; 
it was particularly fatal among children. Dr. Roezer remarked that he 
found it be be most successfully treated with preparations of mercury. If 
that were tlie case, may we not conclude, especially when we lake into 
consideration the tendency to hepatic disorders, that the diarrhoea origi- 
nates in an anormal condition of the bile in respect to either quantity or 

There are no civil hospitals of any importance among the Turks at 
Constantinople. Connected with some of the mosques, there are build- 
ings which answer the purpose of hospitals for the poor. They are re- 
sorted to but little, and only by those who do not possess the pecuniary 
means wherewith to support themselves in sickness. They are here treated 
gratuitously. The Asylum for the Insane, connected with the mosque of 
Suliman, which we have described in an article in a former Number of this 
Journal, may be taken as a fair specimen of these receptacles of the needy 

The hospitals of the Greeks* and Armenians, at Constantinople, are 
superior to those of the Turks, but will suffer greatly in comparison with 
those of Western Europe, or of the United States. I visited one of those 
belonging to the Greeks, accompanying Dr. Pignateili, the physician of 
the hospital, to whom I carried a letter of introduction from Dr. Roezer. 



Medical Institutions^ Slc, at Athens and Constantinople. Ill 

This hospital is in Galeta, adjoining Pera, both of which are generally- 
considered as a portion of the city of Constantinople. The location of the 
building is low, being nearly on a level with the waters of the Bosphorus. 
It is closely surrounded, on all sides, by other buildings, so as to render 
the situation still more unwholesome. It is two stories in height, and sur- 
rounds a court. According to custom, the doctor was accompanied, in his 
visit, by the resident apothecary, two servants, and two priests. One of 
the servants went before, carrying a dish of coals, upon which sage was 
kept burning for the purpose of destroying, or of qualifying, the unpleasant 
odour of the wards. The rooms are comparatively small, containing but 
four or five beds each. They are also very insufficiently lighted and ven- 
tilated, and are not remarkable for cleanliness. The accommodations are 
sufficient for more than a hundred patients, but there were but about fifty 
at the time to which we refer. Among these there were three or four 
cases of phthisis, two or three of ascites accompanied by anasarca, one of 
pneumonia, and one of arthritis. Nearly all the rest were cases of gas- 
tritis and gastro-enterilis, diseases which are remarkably prevalent, more 
so among the Greeks than the Turks, owing to greater irregularities of 
diet and abuses of the digestive organs, by intemperance in both eating 
and drinking. It prevails, however, to a considerable extent among the 
Turks after the commencement of the Bairam. Tliat great annual feast is 
preceded by the Ramazan, the period of fasting, or lent, required by the 
Mahometan faith. The change from fasting to feasting is followed, as 
might be expected, by many cases of imprudence, and these frequently 
terminate in an inflammation of the mucous membrane of the alimentary 
canaL Most of the cases which fell under my notice were accompanied 
by intense pain upon pressure in the precordial and the right hypochon- 
driac region, and, in some instances, in the lower regions cf the abdomen. 
The treatment of these cases by Dr. Pignatelli consists chiefly in vene» 
section, repeated for several successive days, to the amount of ten or 
twelve ounces at a time; leeches to the prsecordia, or to the lower abdomi- 
nal regions; and an infusion of the prunus laurocerasus taken internally. 

In the corner of one of the most obscure rooms we approached a bed, 
upon which lay, in the last degree of emaciation, an aged man sufl'ering 
under phthisis pulmonalis. Dr. Pignatelli was reading the remarks of the 
previous day upon the case, and, before he looked up, one of the priests 
told him that the man was dead. The Doctor, without examining for 
himself, remarked, " E morto questa notte" — he died last night — and pro- 
ceeded to the adjoining room. I saw the patient wink several times, and 
thought he executed the function remarkably well for one who was de- 
clared, by his physician, not to be living. 

Nearly nine years since, a medical school was established in Constan- 
tinople. It iiad but two professors, each of whom, however, was assisted 
by an adjunct. The institution flourished during several years, when re- 
ports of the inadequacy of the professors to fulfil the duties of their sta- 
tions, and of their inattention to those duties, came to the ears of those in 
power. The professors were removed, and others substituted in their 
places, but the school has since continued to languish. Two or three 
years since the Sultan Mahmoud adopted a plan for a university, in which 
there was to be a department for instruction in the medical sciences. The 
extensive and commodious buildings intended for this university, were 
nearly completed at the commencement of the last year, 1839. I went 

112 Medical Education and Institutions. 

from Trieste to Athens, in company with two Austrian physicians who 
were on tfieir way to Constantinople, one to act as chief medical adviser 
to the Sultan, the other to superintend the medical department of the uni- 
versity. If the plan of this institution be carried out as well as it has been 
commenced, it will contribute greatly to the increase of accurate science 
in the dominions of the Sultan. 

Dr. Cathiodori, a Greek physician resident in Pera, was one of the ori- 
ginal professors in the medical school. He still occupies the place of 
physician to the Seraglio, and has amassed great wealth by his practice.* 

He possesses, in a remarkable degree; the vivacity, shrewdness, and 
quickness of perception which characterize his countrymen. 1 spent an 
evening with him in company with a Hungarian physician, and Dr, Ber- 
nard, the Austrian, who was about to take charge of the medical depart- 
ment of the university. As we all boarded at tlie same house we took 
lanterns, which the law requires every one to carry in the evening, and 
went together. We found the doctor in his study, wrapped in a robe de 
chambre, and reclining upon a splendid divan that occupied the whole of 
one side of the room. A large pldiedmanghale^ in shape like an elliptical 
tureen, or urn, stood in the middle of the room, to which it gave a proper 
temperature by the coals and ashes which it contained. Immediately 
after we arrived a servant brought in pipes, and filled and lighted them 
for the guests and the host. Having finished the first pipe, the servant 
brought in tea, with no other refreshments. Each drank a cup, the ser- 
vant replenished our pipes, and thus we continued sinoking, and drinking 
tea, alternately, during the larger part of the evening. 1 mention these 
facts to show the custom of the place. Whoever goes to Turkey, must 
expect to smoke while there, whatever may have been his previous custom, 
if he intend to pass currently, and on sociable terms, in the society of the 
ftatives with whom he may associate. 

Dr. Cathiodori related in the course of the evening, the history of sev- 
eral operations which he had performed. One of them was in a case of 
congenital hypertrophy of the tongue, greatly increased during infancy and 
childhood. The tongue had become enormous, so as to project far out of 
the mouth, and entirely prevent articulation and mastication. It was cut 
off, just within the teeth, by an incision corresponding with the internal 
surface of the inferior maxillary bone and its alveolce. The wound healed 
readily, the tongue assumed its natural form, and the patient could speak 
perfectly well. Another was in the case of a man ef exalted rank, who 
had a tumour of a scirrhous character, situated under the ear and partially 
superposed upon the lower jaw, at its angle. This tumour was at first 
nearly or quite immoveable. No one dared to operate on the case, lest 
if the patient should not recover, it would become necessary to flee from 
the country. The tumour at length became movable. Dr. C. extirpated 
it and the patient recovered. A copious discharge of saliva during the 
operation, convinced the doctor that a lobule, at least of the parotid, was 
involved in the diseased structure. 

No use is made of the stethoscope either in Greece or Turkey, and, 

* Formerly there were seven physicians to the Seraglio, or imperial palace. They 
were on duty successively, each one day in the week. Thus a physician was in con- 
stant attendance upon the Sultan. Dr. Neiner, the Austrian physician before men- 
tioned, resides in the Seraglio, and as the former system is continued, there are now 
two physicians in constant attendance. 

Medical Institutions^ 4^c., of Athens and Constantiiwple. 113 

according to the testimony of the Hungnrian physician, it is but very little 
employed in his native country. Dr. Millengen, an Englishman, has resi- 
ded in Constantinople, or rather in Pera, nineteen years. He says that 
the Turks are mucli more equable in their mode of living than the Greeks, 
and hence, as has been previously remarked, less liable to attacks of 
gastro-enierits. This physician was formerly a contagionist in regard to 
that awful scourge of eastern nations, the plague. But, from long obser- 
vation in the country so frequently doomed to its ravages, be has changed 
his opinion, believes it not to be contagious, and adduces many and forci- 
ble arguments in support of that belief. A woman arrived at Constanti- 
nople, from Trebizond, and made quarantine. She then went to her 
home, was seized with the plague and died. Of twenty-one persons 
who were in contact with her during her illness, not one took the disease. 
There are numerous instances in which one individual in a family has 
died of the plague, and none of the others although exposed, have taken 
it. Cases also are known where persons have slej)t in the beds of plague 
patients without contracting the malady. The mother is sometimes car- 
ried offatid the child at her breast is left unharmed, while on the contrary, 
the child has frequently died and the mother -been left untouched by the 
disease. Dr. Millengen considers the system of quarantine raiher as an 
instrument for political purposes than as a means necessary to prevent the 
dissemmation of epidemic diseases, and thinks, with the distinguished Dr. 
Bowring, who has delivered an address upon the subject before the 
British association, that the system ought to be greatly modified if not 
absolutely and entirely abolished. 

Charles Brown, an American gentleman resident at Constantinople, 
believing the plague to be contagious, has obtained a substance, the basis 
which I presume is chlorine, that he considers as a positive preventive of 
the disease. While the plague was making the most fearful ravages in 
Smyrna and Constantinople in the summer of 1837, this geatleman re- 
quested permission to spend some time in the plague hospital for the 
Franks in the latter city, for the purpose of testing, personally, the vir- 
tues of his prophylactic agent. This request being granted, he remained 
eleven days and nights in the hospital, slept in a room from which patients 
had just been removed and assisted, every day, in dressing the sores of 
the sick and in extending to the patients the other kind offices of a nurse. 
He made constant use of the remedy which we have mentioned, and canje 
out unharmed. 

A traffic in leeches is carried on between the ports of Turkey and Mar- 
seilles. They are purchased in the cities first mentioned at about one dol- 
lar the oA"e, a Turkish weight equal to about two and a half pounds. 
There are from 600 to 700 leeches to the oke. 

The following is a translation of a circular addressed by the Ottoman 
Protomedicus to the physicians and foreign apothecaries at Constantinople, 
and bearing date, November 20th, 1838. 

" Agreeably to the supreme order which scrupulously forbids both phy- 
sicians and pljarmaceulisls to administer any medicines to women whereby 
to effect abortion, we, Protomedicus of the state, hereby caution both the 
former and the latter against being voluntarily concerned, either by giving 
medicine or otherwise, in a crime of such enormity, under penalty of pun- 
ishment proportionate to the offi^nce. We exhort them to be diligent in 
rendering assistance to those women in whom menstruation has ceased 


114 Medical Education end Institutions, 

from some pathological cause, so that they may not be guilty, through inad- 
vertence, of the crime above mentioned. Furthermore, we command all 
pharmaceutists not to sell, to any person whatever, upon mere verbal de- 
mand, any cathartic or emmenagogue medicine, lest they be regarded as 
accomplices in crime and as transgressors of the law which is now in 
force. And to contravene all excuses, either false or true which might be 
made on the part of an apothecary, we hereby oblige every physician who 
may wish to administer such medicines in cases where they are indicated, 
to date and subscribe the receipt with his own hand, declaring in it that 
the patient for whom it is intended is not pregnant. I'his recipe shall be 
carefully preserved by the apothecary, for his exemption from guilt, in 
case of fatal consequences. Those recipes which are not made agreeably 
to the above directions, or which are written by physicians who are 
unknown, will not be recognised. 

" No means will be left untried by this local government to detect such as 
infringe the present law, a copy of which will be forwarded to all foreign 
physicians who are here exercising their profession, and to all the principal 
pharmaceutists. These shall communicate it to others of their calling, as 
well as to the physicians and principal pharmaceutists of the four nations 
who are under our protection, to the end that it shall be vigorously exe- 

"In pursuance of the above, we address ourselves particularly to the prin- 
cipal pharmaceutists, reviving what we have said to them, verbally, that 
they shall rigorously execute this order and cause it to be translated into 
their respective languages, so that none may remain in ignorance of its 

(Signed) Ahmet Effendi, Protomedicus,^^ 

Art. XIIL — Address to the Medical Graduates of the University of 
Pennsylvania, Delivered April 3, 1840. By Samuel Jackson, M. D., 
Professor of the Institutes of Medicine in the University.* 

History, with its eras and epochs, its revolutions, changes and strug- 
gles, is the record of the events to which the opinions, the interests, and 
the actions of men have given birth. It is the interior of man's life, re- 
vealed in things that belong to time and this world. 

The life of every individual, is a history, not less solemn and important. 
Though apparently and viewed outwardly, trivial, and often insignificant, 
it is eventful of most deep consequences. It involves the eternal destiny of 
an immortal soul. It is the interior life of man, passing through the meta- 
morphic changes of time, to come forth in a persistent form, in the end- 
lessness of eternity. 

The present is an epoch in the history of your lives. You have just 
passed one stage: you are about to commence another. You have been 
engaged in the great duty of forming the character, of acquiring the know- 

* This address has been requested for publication by the Graduates. Its merits 
seem to us to justify our departure from the rule we have adopted of restricting our 
pages to articles of a more directly practical character. 

Jackson's Address. 115 

ledge, and of obtaining the requisites necessary to fit you for a profession, 
regarded as one of liie most respected and useful in society. It involves, 
moreover, serious responsibilities in its exercise. 

The present is, then, a period for thoughtful reflection. The past, , 
you are no longer masters of. It is beyond your control, and stands as 
evidence in favour of, or against you, according to the tenor of your con- 
duct. Turn it now to future benefit. Reflect well on it: scrutinising it 
closely, and with manly firmness, look into what may have been your de- 
ficiencies, scan your errors, call forth and castigate your misdeeds. The 
unvvhipped faults of youth, become the misdemeanors and crimes of mature 
life. But while you impartially weigh wherein you have been defective, 
you can contemplate with self approving satisfaction, those actions, and 
the conduct meriting applause, deserving your own, and earning the ap- 
probation of others. 

The present occasion is an honourable testimony in favour of your ap- 
plication, your diligent pursuit of your studies, of your proficiency in 
your professional knowledge, and general moral worth. Without satisfac- 
tory evidence on these points, the honours of this University are not con- 

The class attending the courses of the University, the session just closed, 
was larger, with one or two exceptions than in any preceding year. It 
was not less distinguished for its orderly demeanor, its respectful attention 
to the lectures, and its general ardor in pursuit of knowledge. 

The candidates for the doctorate have been unusually numerous. They 
have been subjected to a more rigid and sifting examination, than has been 
usual. This ordeal you have stood, and have acquitted yourselves to the 
satisfaction of the Professorial Board. You have had conferred on you 
the diploma of this University, the highest evidence of acquirement in the 
science of medicine known in this country. 

Though the past may present to you, as it will to all who subject them- 
selves to a proper scrutiny, much to correct and reform, yet will you find 
in it that of which you may be proud. Cherish and persist in tfie good; 
repress and amend the bad. This mingling of good with ill, is the com- 
mon quality of man's character. 

"Our virtues would be proud, if our faults whipped them not." 

The future is before you. How much lies buried, impenetrable to eye 
or thought, in that future! Flushed with recent success, anticipated hopes 
brighten the eye, and gleam upon the brow. To what extent these will 
be realized, how little of what is promised will come to pass; how much 
unforseen events and changes will blight and destroy, no prophetic eye 
can discern. This unknown future, it is your duty to prepare for. It 
flows on a vast flood of events, which cannot be stayed or turned aside. 
But, if we cannot master and control the events of time, we may possess 
ourselves of the qualifications adapting us to take advantage of them, as 
they arise. We can so conduct ourselves as to convert them into benefits, 
and to render them promotive of happiness, if not prosperity to ourselves 
or others. 

"The fault, dear Brutus, is not in our stars, 
N But in ourselves, that we are underlings." 

116 Medical Education and Institutions. 

Human power cannot command and govern the exterior circumstan- 
ces of the world, and bend tiiem exclusively to man's purposes. They 
are directed by a divine and superior agency, to accomplish ends intended 
from eternity. Men are the instruments made use of for their accom- 
plishment. They are endowed with the qualities fitting them for that 

If we can not change the fixed order of exterior events and circum- 
stances, it is- in our power to regulate and control ourselves, to form our 
principles and characters, to constitute and govern the interior circum- 
stances of our nature. In this manner, man can adapt himself to the 
events that overtake and involve him. He proceeds with them, may appear 
to give them direction and control, for he works with them, and reaps 
fortune and fame: or should he fall a victim to their overwhelming power 
when placed in opposition to them, he bows in submission and resignation 
to the irrisislible destiny of a divine law. 

The highest ambition of any individual as it respects this world, should 
be, to qualify himself, by a just understanding and preparation of the pow- 
ers he possesses, for accomplishing some one of the infinity of ends, that 
can be perfected in the great movement of our social scheme, by any one 
generation of men. No one individual, it is probable, more than another, 
is selected by Divine Providence for a given end. He has provided, in 
the immense variety of mental, moral and physical qualifications, for the 
combinations necessary to form the character adapted to any especial pur- 
pose. It is always existing. The occasion and the opportunity for the 
calling of it into action, are alone required, when it appears on the stage, 
in its place and time. 

The success of one individual more than another, in any particular 
department of science, or line of pursuit, depends on his being always 
ready to seize on the opportunity and occasion, as they may ofljer, by 
which he can be introduced on the field of action, and his powers be 
brought into play. 

" There is a tide in the affuirs of men, 
Which, taken at the flood, leads on to fortune." 

The difficulty that besets most men, is, either that the opportunity does 
not present itself when they are prepared: or, when it arrives, they have 
neglected the preparation that is required. Opportunity once lost, is lost 
forever. It seldom comes a second time. 

The beautiful apologue of the ten virgins, is not less applicable in a 
worldly, than in a religious meaning. 

Be like unto the wise virgins, have your lamps trimmed and your oil 
ready, that when the bridegroom (opportunity) cometh, you may enter in 
and reap the enjoyment of your foresight and precaution. But if, like the, 
foolish virgins, you neglect your lamps, have no provision of oil, and 
when the bridegroom cometh, you have then to look after your neglected 
means, the door will be shut, and you will in vain seek for admission. 
Neglect and oblivion will be your portion. 

From this moment let it be a fixed determination of your minds, to 
devote yourselves to the fullest preparation, for the exercise of the social 
and professional duties that will devolve on you. A mission of more or 
less importance to be fulfilled in this world, is placed within the reach of 

Jackson's Address. 117 

every individual. It is a responsible obligation of man to his God; of the 
creature to the Creator, that hewilfully neglect not to execute that mission 
to tiie extent of his abilities. 

You have received from your instructors, in their separate valedictories, 
at the close of their courses, advice appropriate to each department. You 
are now about to separate from the Alma Maler, under whose fostering 
care you tiave been raised to your present position; and under whose 
auspices you enter on the world. 

In her name, I am deputed, though it would come with more grace, and 
be more appropriately performed, by a higher funciionary, to bid you fare- 
weh; and to address to you some observations and admonitions, that may 
direct your atiention, more specifically, to the duties and obligations you 
will be called on to perform and observe in your line of conduct. 

These duties may be classed under those that are professional, and those 
that are social. 

The first, or your professional obligations, are of different kinds. They 
may be placed under the following heads: and it is to them I shall confine 
my observations. 

1. The obligations of forming your professional character, and of com- 
pleting your professional acquirements. 

2. The obligation of contributing to the advancing or perfecting of Me- 
•cal Science. 

3. The duties you will owe to your professional brethren. 

And, lastly, the duties you will be called on to fulfil to your patients. 

A few very cursory remarks will be submitted to you on the above order 
of duties. 

I. The formation of a professional character of an elevated order, is es- 
sential to distinguished success as a practitioner of medicine. The found- 
ation of this character must be laid in the cultivation of a strong love of 
truth, of justice, and of benevolence, sustained by a profound conviction 
of the great truths of religion. 

A character into which enter these elements, must always command re- 
spect and confidence: without them, no one can ever be truly great. 

But to these important moral qualifications must be combined, zeal and 
assiduity in the gaining of knowledge, of practical tact, and of experience 
in your profession. 

You have received, as the reward of your past exertions, the diploma 
admitting you to the doctorate. You are now to make yourselves Physi- 
cians. Do not fall into a common error in supposing that, with the school 
ends your education; that you have terminated your studies. They in 
fact now take a higher order, and a new direction. Your labours will in- 
crease, not diminish. 

Courses of lectures are not intended to complete, nor can they complete 
a medical education. You have been grounded in the elementary princi- 
ples and knowledge of your profession, as it exists at the present time. 
You have now to make yourselves acquainted with the science, as it has 

The works of the illustrious dead of past ages; those who have left be- 
hind them a. living and during memory, as observers of nature, should be 
perused by you. Original writers of this character are {ew. One or two 
authors in each era of the science, may constitute the extent of useful re- 
search in this respect. The great mass of writers have done little m,ore 

118 Medical Education and Institutions, 

than repeat and comment on the opinions and doctrines of the original few 
who preceiled them. 

It is more important that you should obtain, as early as possible, prac- 
tical knowledge by immediate observation. Neglect no means for this 
purpose. Frequent hospitals, follow the attendance of dispensaries, be- 
stow your services on the poor, so many of whom require and gladly avail 
themselves of medical assistance. The principal object you should aim 
at, is to acquire a knowledge of disease. The symptoms alone should not 
engage your attention. They are the signs by wliich a disease is mani- 
fested: the}^ are not the disease. What is of still more consequence, is, 
that you siudy, by close attention, the natural history of diseases, the ex- 
tent of the natural powers of the economy in their cure, and the methods 
that nature adopts, in the play of the reactive forces and operations of the 
system, to disembarrass it of disease. This information is the most cer- 
tain basis of a safe, sound and judicious treatment. It is to be acquired 
by the bed-side, where you must watch the progress of a case, as it tra- 
verses its difl'erent stages, and note, in writing, as they occur, the pheno- 
mena you witness. 

Most young praciitioners mistake the proper object of their clinical stu- 
dies and observations. They believe the first and great object to be at- 
tained, is the prescribing of physic. This is a vulgar notion, cherished by 
the general ignorance of society as to the true nature of medical science, 
and the proper character of a physician. It is difficult to resist the impor- 
tunities of patients and friends of the sick, who expect from the adminis- 
tration of drugs some miraculous influences: it is difficult to divest our- 
selves of the belief, so flattering to self-love, that with our physic, we are 
omnipotent in the power of controlUng the economy according to our 
views, and of overcoming disease. 

Tiie last and least important part of the science of medicine is, the 
dosing of patients with medicines. Understand me: do not suppose I 
undervalue the immense services derived from the judicious administration 
of medicines in the treatment of disease. Medicines produce in the 
animal economy operations, such as nature is observed to excite, as the 
means of restoration. These processes of nature, the physician imitates; 
he excites them, artificially, with his medicines, or other remedies. When 
they are done happily, at the appropriate time, and in accordance with 
the natural law of the disease, they prove most beneficial, and are curative 
in their operation. But when the medicinal operation and disturbance 
are inopportunely provoked, when they come in conflict with the natural 
law of the disease tending to its solution, confusion and new disorder in 
the functions and organs are the consequences. The result will be to 
retard the recovery of the patient, to produce chronic disorders of long 
suffering, or destroy the power of recovery. Vel educes quas educenda 
nan sunt; vel augebis morbum; vel jugulabis segroturn. 

Most physicians learn, from experience, that often their highest art 
consists in amusing the patient, inspiring confidence, and thereby quieting 
the system, that would otherwise be disturbed from nervous agitation, by 
some imaginary remedies, while nature is permitted undisturbed to accom- 
plish the cure. 

The laws of nature are God's ordinances in the natural world. Man 
can do nothing without them or against them. It is the first and great 
object of every scientific practitioner of medicine, to study them and to 

Jackson's Address. 119 

master them, as they are displayed in the life-mechanism of living beings. 
Of these laws, it is his pride and boast, that he is the minister and inter- 
preter. He is the servant of God, ministering to and alleviating ihe tem- 
poral and physical wants and infirmities of suffering humanity in the mode 
of his appointing; just as the ministers of our holy religion are God's 
servants, ministering to and watching over the spiiilual failings and the 
endangered condition of man's soul, according to his revealed will. Medi- 
cine is a mission and a ministry, inferior only to that of religion. 

II. It is not less an obligation, that you should exert your powers in 
contributing to advance and improve the science of medicine, than it is to 
perfect your own knowledge. Medicine regarded as an art, or a science, 
all are ready to acknowledge, is imperfect. That it can be advanced to a 
much higher degree of completeness, cannot be doubted by any who are 
familiar with what medicine has been, what has been done wiihin a few 
years, and what is doing in the science. 

The advancement of medicine, consists in the greater accuracy and ex- 
tension of its facts; with an adherence to a more rigid method of loijic and 
reasoning. It is assuming daily more of the character of a physical and 
positive, ;ind losing that of a speculative and metaphysical science. 

General theories are but little in vogue. The versatility that prevails 
in diseases, forbids the expectation, that any one doctrine ever can embrace 
conditions, so endless, diversified and fluctuating. 

Causes of a general nature, inappreciable except by the phenomena 
they produce, acting in periodical cycles of varying duration, exert pro- 
found modifying influences of diflferent nature, on organised beings, more 
especially on the vital energies and organisation of the human race. From 
these, result not only the great epidemics, dissimilar at each period, that 
prevail over whole zones of the globe, but the especial periodical constitu- 
tions that impart a common character to nearly all the diseases occurring 
wiihin that cycle. A doctrine founded on the facts, as they then are ob- 
served; and a system of treatment, adapted to a particular constitution, or 
to a particular epidemic, may be arranged. They will be true for the 
time: but must fall, as that constitution, or epidemic influence passes away, 
and a new revolution has brought forward a new train of morbid conditions 
and phenomena. 

In these circumstances are found the explanation of the diversified 
theories and modes of practice, that have prevailed at difl'erents times in 
medicine, 'i'his has been urged as a reproach on the science and our 
profession. It is the consequence of things as ordained by the (Creator. 
A. theory and practice are true and applicable only for a time. A general 
and persistent theory is an absurdity in medicine — medical theories must 
be numerous and variable, for the facts, of which a theory is the aggre- 
gate exponent, are themselves, for the most part, complex, variable and 

You must not, then, wed yourselves to any theory, nor permit your- 
selves to be enlisted as partizans to any doctrine or practice. Use your 
theories as a lame man does his crutches; but be ready to throw them 
aside, as soon as they are useless. 

The advance of medicine consists in the establishment and verification 
of facts. But what an endless labour is here opened to the profession. It 
extends over the whole field of organised beings, vegetable and animal, 
from the highest to the lowest in the scale, in their natural and diseased, 

120 Medical Education and Institutions. 

or unnatural conditions. In all these are presented the phenomena of life 
and organisation; the products of life and organisation; and the ajrents that 
influence the vital and organic phenoniena in all their states. These bear 
with more or less force on medicine, as a science, in illustrating the com- 
plicated, obscure, and, without this collateral aid, incomprehensible phe- 
nomena of the human economy, the more especial object of medical in- 

It is to facts that alone can illustrate inedical science, that you should 
devote your time and attention. Whatever may be the particular bent of 
your genius, or the kind of talent you possess, there is, in medical 
researches, some one pursuit adapted to it. You can have no excuse for 
negligence. The qualifications for these objects, are industry, persever- 
ance, application. These are in the power of each of you. They alone 
may enable you to establish important truths to be embodied in the 
science. Facts admitted into science, may be regarded as medallions struck 
to commemorate an event, or to perpetuate a renown. They carry to 
remotest time the name of their discoverers. 

The labour given by most men to the acquisition of wealth applied to 
scientific objects, would confer on you a celebrity — would make your 
labours useful to future generations, as to the present. To a generous 
mind these are far more exciting motives, than the more sordid feelings of 

It is unhappily true, that the active commercial spirit prevailing in this 
country and England, gives to the, possessor of wealth, an undue power 
and influence. It represses an intellectual class; it places the moneyed 
interest at the head of society. A scientific and literary class, possessing 
a weight and power in society, is yet to be formed in this country. Our 
literature and science are cultivated in subserviency to the advancement of 
fortune. We work for money; not for truth or fame. Combat against 
this feeling. To the rising generation entering into the learned profes- 
sions, and to the press, must our Republic look for safety against the 
threatened overthrow of its constitutions, from the corrupting influence of 
wealth on our manners. The indignant outcry of the Roman satirist, 
against the venality of the Roman people, in the last days of the Republic, 
would appear as though extorted by a contemplation of our present state. 

" The first great wish that all with rapture own ; 
The general cry to every temple known 
Is gold, gi.'ld, gold — and let, all gracious powers. 
The largest chest the Forum boasts be ours." " 

The direction that medical investigation has taken is the analysis of 
organic phenomena, and their reduction to the simplest possible elements. 
It is the second stage through which science must advance to reach its 
completed state. In the first period, phenomena can be known only as a 
unity. The reasoning founded on them is consequently erroneous. In 
process of time it is recognised, that the phenomena, regarded as simple, 
are complex. Analysis is then attempted: this is the character of medical 
science at the present day. It is analytical. In the last period of a 
science, that in which it has reached its ultimate development, the pheno- 
mena, reduced into their separate elements, are reconstructed as^ain into 
unity. But they are known as unity embracing diversity. Comprehended 

Jackson's Address. 121 

in all their relations, they can then be constituted into the natural order 
and arrangement, in which consists a just theory. 

Organic phenomena, from their extraordinary complication, could not 
be approached by analytic processes, until the collateral sciences had 
reached a sufficient degree of perfection to furnish the means. This period 
has arrived. Organic phenomena are attacked by every method of analysis. 
This is exemplified in the history of organic structure. General anatomy, 
or the reduction of the organs to tissues, commenced in our time, is now 
completed. The tissues themselves, are now undergoing a further reduc- 
tion to simpler elements and forms. The microscope, brought to so much 
perfection, as to be free, to a great extent, from the defects that rendered it 
at times delusive, is an important means by which this is accomplished. 
The result is the creation of microscopic anatomy. Two great works are 
now issuing from the press devoted to this subject. The one, the splendid- 
publication of Professor Berres of Vienna, '' Jinatomia Parfium Micro- 
scopicanim Corporis Hmnani:^^ the other, a more complete and equally 
splendid work by Professor Mandl, of Strasburgh, ^^ Anatomie Micro- 

Besides the above large and general works, numerous contributions have 
been made by other distinguished observers, on the microsopical structure 
and composition of the tissues and fluids. Professor Henle of Berlin, 
has made a most elaborate demonstration of the organization, the physi- 
ology and pathology of the mucous tissues. Erdmann, Valentine, Bur- 
dach, Wagner, and others have furnished new and important facts on the 
elementary organization of the nerves and muscular tissues. 

Time will not admit of the many examples that could be adduced of 
the new facts and new views, arising out of them, in anatomy, physio- 
logy and pathology, derived from microscopical researches in those depart- 

Organic chemistry is not less rich in its contributions to anatomy, physi- 
ology, and pathology, and will soon tlirovv a brilliant light on the dark- 
est spots of our science. 

It will not be accounted rashness, by those who have looked into this 
subject, when I assert, that under the searching analytical review of the 
facts of medicine, and application of analytical philosophy to medical 
science, a large portion of what has been received, and is regarded as 
established, will be changed, or swept away. Doctrines and opmions 
founded on those facts, now holding sway, must disappear. They will 
take their place in the history of the science: they will not belong, as 
now, to the science. 

But what are we doing in this stirring and busy time, contributing our 
aid to the improvement of our science? I fear, it must be said, almost 
nothing: who amongst us is at work in these new fields of scientific 
research, seeking imperishable fame? I fear, it must be said, no one. 

Three years have this day elapsed, since a young student, full of zeal 
and ambitious ardor in the pursuit of knowledge, stood on this stage, 
and received, as you have, the honored diploma of this school. He pre- 
sented to the faculty as a thesis, an elaborate essay, in which he confirmed 
Miiiler's discovery of lymphatic hearts or pulsatory lymph organs, in the 
Batrachia, and extended it by proving their existence in other animals. He 
did not abandon the course he had comnjenced so well. He continued 
cultivating comparative physiology and microsopical investigations, though 
No. LI.— May, 1840 11 

122 Medical Education and Institutions. 

his means were but moderate. He published as a part of his labors, about 
two years since, an interesting series of observations on the venous circula- 
tion.* He was engaged earnestly in pursuing these objects, and but a 
short time since, I could have answered the question by adducing Dr. Alli- 
son as one, who promised to illustrate by his talents and industry, this 
department of American science. But alas, his career is ended. A hw 
days since, and his body was consigned to the tomb. Frail in constitu- 
tion and delicate in form, he fell a victim to his exertions. A wound, 
received in dissecting an animal, on which he was making observations, 
was remotely, as I have been informed, the cause of his death. 

The war-trump, and the muffled drum, and the measured tread of 
armed men, and the musket shot pealing over the grave, honor the death 
of the soldier, the slaughterer of his brother man. But the student who 
meets his death battling for truth in the great arena of science, passes to 
an unknown grave, followed by the regrets and the tears of the few who 
knew his worth. Yet there is another judgment, and another reward than 
that of man. A brighter glory will arise from the obscure grave of the 
unknown student, than ever yet surrounded the blood-stained monument 
of the warrior of an hundred fields. 

You must necessarily, gentlemen, before you become deeply engaged 
in the absorbing occupations of the practice of your profession, pass some 
years with much unoccupied time. Apply this to the pursuits to which 
I have directed your attention. The field is almost a virgin soil. You 
can scarcely fail to earn a brilliant reputation, and lay the foundation for a 
successful professiouBl career. 

HI. Permit me to point out a few prominent duties, that will devolve on 
you in your intercourse with your professional brethren. Much of your 
future comfort, and no small part of your success in your profession, will 
depend on the relations you maintain with them. 

It is impossible to avoid collision of interests or opinions, with those 
occupied in the same pursuits as ourselves. Society itself, is maintained 
in vigorous existence, by the moral actions and reactions of men on each 
other, acting in masses or individually. The conflicts thence arising excite 
our energies into activity. If governed by elevated moral principles; if a 
sense of truth, of justice, of honesty of intent and action, preside over our 
conduct, no hostile feelings are engendered by them. 

In the medical profession, the sources of aifl'erences in opinion and col- 
lisions of interest, are more numerous, probably, than in any other. 

It is not possible that all individuals can view the very diversified and 
incessantly varying phenomena, presented to medical observers, in the 
same light. 

It is equally true, that modes of treatment the most opposed to each 
other, can be made to produce the same results. There may be a choice 
as to one or to the other, but statistical tables have not yet been Ibrmed, 
that would demonstrate in figures, which is to be preferred. 

'J'oleration of difierences of opmion, as regards doctrine or practice, is 
an absolute duty imposed on every conscientious mind. VV here there is 
difl^erence, our duty is to examine, not to condenm and reject. 

No one has a right to presume, iliat riis opinions are the standard to 
which all others are to conform. This assumption and intolerance arising 

* See this Journal for August, 1838. 

Jackson's Address. 123 

from a false pride of opinion, have been frequent causes of idle contro- 
versies, productive of embittered feelings, without deciding a single ques- 
tion agitated. Eschew on all occasions controversies. Truth is never 
elicteH by them. Be always ready and willing to enter into investigation. 

The more frequent cause of professional (Hfficulties, arises out of the 
business of a physician. His interests are here involved, and these touch 
us more nearly, than the questioning of our opinions. 

Few occasions of this kind would exist, could man understand his true 
interest, in respecting the rights and interest of others, while prosecuting 
his own. Too olten the immediate and momentary gain, occupies the 
whole mental vision; the reactions of violated rights, of wo-unded interests, 
are overlooked. By an act of injustice, an enemy is made, and the con- 
fidence of others impaired. Suspicions of unfair dealing, of trickery, of 
unrestrained selfishness, overshadow the character, and, from precaution 
or self-defence, your standing is depreciated, or the courtesies of the pro- 
fession refused. 

I cannot, at this time, enter into the detail of the conduct you should 
observe, in the relations that bind you to your brethren. Every man of 
good sense, possessed of honourable sentiments, and a moral feeling of 
right and wrong, by the instinct of honesty, will know how to conduct 
himself, without a code to regulate his deeds. 

It may be permitted me, however, to speak on a few points more cir- 
cumstantially for your guidance. 

A physician, in attendance on a patient, has a right to expect from the 
common courtesy that should govern a gentleman, that no other would 
interfere in visiting and in advising a patient, or in giving an opinion on 
the case; or seek, by any underhand proceedings, to weaken the confi- 
dence reposed in him. 

Called to a consultation, if you find, on investigation, that your colleague 
has fully understood the nature of the case, and has pursued a judicial treat- 
ment, sustain him in the course he has adopted. Suggest no change that is not 
indispensable. It might be construed into a disposition to show that you 
could amend, in some respects, what had been done. This course is more 
especially to be observed towards a younger member of the profession 
whose reputation is not yet established. 

Whatever passes in a consultation is not to be the subject of conversa- 
tion to others. If consultations are to prove really useful, there must 
exist the most perfect confidence between the parties, leading to a full and 
free communication of opinions, views, and experience. But this cannot 
be expected, where it is known, that what occurs may be promulgated, 
and made the subject of comment and indiscriminate conversation. 

Do not suffer yourselves to give opinions respecting the judgment or 
practice of others, in any particular case, on the ex parte statement of 
patients or their friends. Never implicate a fellow-practitioner on such 
statements. They are inaccurate or false, and your opinion will certainly 
be incorrect and unjust. 

Physicians are often treated with great injustice, from capriciousness, 
or other unw(n'thy motives, by those whom they have attended. Discoun- 
tenance this conduct, and sustain, as far as lies in your power, the feelings, 
the character, and reputation of your compeers. 

We cannot prevent individuals from exercising their freedom of choice 
in selecting their medical attendants. But we can, in all cases, take care 

124 Medical Education and Institutions. 

that those who have preceded us have been treated courteously in their 
dismissal; that their feelings have not been outraged, and that their in- 
terest is secured. 

By the observance of the above rules, and the general principles pointed 
out, a reputation for fair and honest dealing will be formed, that must com- 
mand respect and confidence. 

Personal differences and degrading disputes will be avoided, and the pro- 
fession, by the harmony and combination of its members, will exert a pow- 
erful and a salutary influence on ihe moral condition of society. 

IV. The last order of duties to which I shall direct your attention, are 
those that relate to your patients. 

You are selected by them from confidence reposed in your knowledge, 
judgment and skill. Take heed that you justify that confidence. Omit 
no means, spare no pains to understand the case you have in hand. In- 
vestigate it closely; examine into the state of every organ and function of 
the body. Before you undertake to treat it with remedies, satisfy your- 
selves as to the seat and nature of the afl^ection, and determine what is to 
be done, and what is not to be done. 

In chronic cases, review the wh-jle life of your patient. Let nothing 
escape your research. The diseases of a former time, early or later habits, 
the state of mind, the business, occupations, modes of living, every thing 
that could have exerted a permanent influence, are to be brought into re- 

In acute cases attended with danger, be assiduous, even to overwatching, 
in your aiientions. In doubtful periods, make your visits, for your own 
satisfaction, more frequently than may be actually necessary. But do not, 
in that case, burthen your patients with charges for them. When life is 
in great danger, and depending on your skill,' remain with your patient 
until the event is decided. 

The intercourse of a physician with his patient, must be of the most 
confidential nature. There are occasions when it is necessary that the 
mind should unburthen its inmost thoughts, and the heart pour forth its 
hidden secrets. That which is of deeper interest than life itself, must be 
confided to the physician. But for this the most implicit reliance must be 
placed in his secrecy, his integrity and honour. 

Make it a rule to speak of your patients, their affairs, their families, their 
diseases, with the greatest reserve. In referring, as may be sometimes 
necessary, to their cases, do not mention names. The patient must feel 
assured that the physician is a depository, in whose bosom every trust is 
sacredly preserved. 

One of the most delicate oflices the physician is called on to perform, 
is the communication of a fatal termination to a disease. The inevitable 
result is known to him, in many cases, long before it is suspected by the 
patient or his friends. Your opinion will be looked to with anxious soli- 
citude. Never deliberately deceive. According to the circumstances, be 
more or less explicit in giving your judgment to the friends and to the pa- 
tient. You cannot always be frank and open, expressing in the clearest 
manner your convictions on these occasions. When you find it necessary, 
prepare gradually the mind for the reception of the truth; but never buoy 
up with false hopes you know must be disappointed. 

To many persons, from a happy temperament, or a more happy prepa- 
ration of the mind, sustained by elevated principles of religion, death pre- 

Jackson's Address. 125 

sents no terrors. They rise above the weaknesses of common natures. 
To them death comes as a friendly messenger, surrounded with beautiful 
attributes, to announce the change from time to eternity; it is a blessed 
harbinger, summoning to a brighter and holier existence, in the eternal 
communion of the virtuous and the just, with the Creator. With such 
you need have no concealment. 

There are others, again, whom the thought of death overcomes with 
dread, and sinks in despair. A premature communication would prove 
disastrous. Provident nature has not been neglectful in this our greatest 
need. A period arrives in the failing of the powers of the system, when 
life is felt as a burthen, and the soul, yearning for its native and eternal 
home, longs to escape from its corporal thraldom. The most timid no 
longer dread it. Though but of late, the mind refused to contemplate it 
as a thing too fearful to be looked on, it is now welcomed with pleasure, 
and sought for as a relief. Wait with such, until you perceive this state 
approaching. Your tidings, then, will not be of sorrow, but of great joy. 

Many other topics might be introduced and expatiated on. They must 
be left to your own judgments and discretion, which, fortified and directed 
by sound principles, will not fail to suggest an appropriate conduct as cir- 
cumstances may require. 

The connection, gentlemen, that has subsisted between you and this 
institution, now ceases. You pass from under its fostering protection, to 
wend your way in the devious paths of life, guided by the principles you 
have here imbibed. 

The interest you have excited in us, will not cease. Success and re- 
nown in your profession, reflect honour on your instruction and your 
school. FaiUire and disgrace tarnish tlieir reputation. Take with you 
our blessing: and believe us most sincere in our wishes for your happiness 
and prosperity. Go forth on your great mission; and, in its successful 
performance, reaping golden opinions from your fellow-men, may you be 
hailed in their grateful aspirations, " the hands of heaven." 

In the name of my colleagues and myself; in the name of your Alma 
Mater, I bid you farewell. 




Art. XIV. Eletnents of Physiology. By J. Muller, M. D., Professor 
of Anatomy and Physiology in the University of Berlin, <fec. Trans- 
lated from the German, with notes. By William Baly, M. D., &;c. 
Parts 3, 4, pp. 258, 210. London, 1838. 

Of the first two parts of Pr6fessor Miiller's Elements of Physiology 
we have given, in a former Number, as complete an analysis as the nature 
of the work and our limits would permit, and we are persuaded that no 
apology will be necessary for our calling the attention of our readers, even 
at this late period, to the two succeeding parts, which complete the first 

The portion of the Elements now before us, embraces Books three and 
four of the author's general division, comprising the physiology of the 
nervous system, and of motion, voice and speech. These important and 
intricate subjects are discussed with the author's usual ability — the present 
state of our knowledge in regard to them is presented in a clear and satis- 
factory manner, and the utmost caution is taken to separate established 
facts and logical deductions from hasty and imperfect observations and 
mere hypotheses. The third book certainly comprises the very best com- 
pendium extant of the physiology of the nerves and of the central organs 
of the nervous system; and although, from the very nature of the subjects 
treated of in the fourth book, the student will find it less satisfactory, it is 
nevertheless as lucid and complete as the materials in the possession of the 
author would permit. 

The consideration of the nervous system commences (section 1) with 
the properties of the nerves generally — After considering the principal 
forms of the nervous system, as displayed in the radiata, mollusca and 
articulata, with a brief notice of the opinions of leading physiologists in rer 
gard to the relation in which the nervous system of invertebrate animals 
stands to that of the vertebrata, the author proceeds to an exrimination of 
the minute structure of the nervous system. He describes the nerves as 
constituted of large and small parallel fasciculi, invested by a membranous 
neuriiema. These fasciculi are found to be connected with eacli other at 
intervals — but the parallel primitive fibres contained in these fasciculi run 
in apposition with each other merely; they do not unite — Even when the 
fasciculi appear to anastomose, there is no union of fibres, but merely an 
interchange of fibres between the fasciculi. The structure of the primi- 
tive fibres was first correctly pointed out by Fontana, who distinguished 
in them an external tubular portion, which, when highly magnified, has a 
wrinkled aspect, and a solid internal portion, which forms a smooth ho.uo- 
geneous thread. In some fibres he was able to separate the tubular sheath 
from its solid contents. Remak has recently confirmed the accuracy of 
these observations of Fontana. He describes the contents of the nervous 

Miiller's Elements of Physiology. 127 

cylinder to be either a perfectly solid fibre of rather less diameter than the 
cylinder itself, or a flattened pale fillet separable by pressure for a conside- 
rable extent here and there from the investing tube, which is prone to be- 
come wrinkled or puckered. 

The tubular structure of the cerebral fibres is described by Fontana and 
by Ehrenberg. The latter states that these fibres, in the brain and spinal 
cord, run generally in straight lines, and do not anastomose. He saw them 
divide in but very few instances, as in the spinal cord sometimes. Pro- 
fessor Miiller remarks, however, that — 

"The division of the fibres may be more frequent even in the brain, since 
the mass which the diverging fibres constitute evidently increases between 
the medulla oblongata and their radiated expansion in the gray matter of the 
outer part of the optic thalamus. The nature of the contents of the delicate 
tubes in the brain was not hitherto quite accurately known. It appears to be 
rather gelatinous than solid; some indeed have found it of oily consistency. 
Remak states that it is, as in the fibres of nerves, a coherent thread; but, like 
the tube itself, of a much more delicate nature." 

From the observations of Treviranus, Valentin, and Weber, it would 
appear that the fibres of the brain, spinal marrow, and all nerves, are, in 
the perfectly fresh and uninjured stale, uniforndy cylindrical, without any 
enlargements, but that a varicose or beaded appearance may be produced 
in them by pressure. The tendency to assume a varicose appearance, is 
set down by Miiller as a characteristic properly of the fibres of the brain 
and the nerves of special sense. It is not quite certain on what this pro- 
perty depends. 

The fact of all the nerves containing both white and gray fasciculi is 
now fully established. Tluis the cerebro-spinal nerves contain some few 
gray fasciculi mingled with the white; whde, in many parts of the sym- 
pathetic nerve, Remak has detected white fibres mingled with the proper 
gray or organic fibres. According to Remak, the two sets of fibres differ 
in structure; the white being not only much larger tfian the gray, but the 
difl^erence of the tube and enclosed fibre is also in them always distinct, 
while the more delicate gray fibres have rather a homogeneous aspect. 
The surface of the gray fibres is here and there beset with very minute 
granules, similar to those on the twigs of the minute blood vessels, for in- 
stance, in the brain. 

Between *the anterior and posterior roots of the spinal nerves, neither 
MUller nor Ehrenberg could detect any difljerence of structure. 

Agreeably to the observations of VVhytt, Prevost and Dumas, the accu- 
racy of which has been confirmed by Professor Miiller, the primitive ner- 
vous fibres remain distinct and isolated throughout their course; the cere- 
bral extremity of each fibre being connected with the peripheral extremity 
of a single nervous fibre only, and the peripheral extremity being conse- 
quently in relation vviih only one point of the brain or spinal marrow; so 
that, corresponding to the many millions of primitive fibres which are given 
oflf to peripheral parts of the body, there are the same nuniber of pe- 
ripheral points of the body represented in the brain. Consequently the 
notions heretofore maintained in relation to the nervous connection of dif- 
ferent organs, and of the cause of the sympathetic relation which exists 
between certain parts of the body, are altogether erroneous. The frequent 
anastomoses observed in certain nerves is caused by a primitive fibre pass- 
ing, in its course, from one nerve into another. 

128 Reviews, 

" By the aid of minute dissection it is easily seen that when a branch is given 
off, the fibres in the trunk do not divide into two, one remaining in the trunk 
while the other leaves it to join the branch; but that the fibres of the branch are 
some of those which already existed in the trunk: hence, in a nerve, very dif- 
ferent fibres, sensitive and motor, may be associated together, and in the trunk 
of a nerve there may even be branches contained which do not unite with the 
other constituent fasciculi, and have no resemblance to them in its properties. 
Thus the nervus mylo-hyoideus, a motor nerve, is commonly regarded in a ge- 
neral way as a branch of the inferior dental, a nerve of sensation, although these 
two nerves have nothing in common except their position side by side; and of 
this there are frequent examples- We hence see that the properties of the com- 
ponent fasciculi have nothing to do with the nature of the trunk of the nerve 
itself; but that, on the contrary, the nervous trunk, particularly at some distance 
from the brain, may be constituted of fasciculi of very various properties, the 
different fasciculi destined for a particular limb having become annexed to it in 
its course." 

" It is found that the nervous fibres terminate either by the formation of re- 
gular anastomosing loops between every two fibres; or by uniting so as to form 
a network like blood vessels; or, thirdly, they all terminate in an isolated man- 
ner, without being connected together. The first v/as observed by Prevost, 
Dumas, Valentin and Emmert to be the mode of termination of the nerves in 
the muscles; and by Breschet, Valentin and Burdach it was observed in the case 
of the nerves of sensation: the second, or reticular mode of termination was 
seen by Schwann in the mesentery of the frog and firetoad (rana bombina), and 
in the tail of the larva of the toad: the third was discovered by Treviranus in 
the eye and ear, and the observation is confirmed by Gottsche." 

According to Valentin, the primitive fibres of the spinal nerves do not 
end in the spinal cord, but continue their course as far as the brain. In 
the white substance of the brain, the fibres lie in contact with each other; 
but at the line of contact of the while and gray substances, the fibres be- 
come separated by globules of gray mailer, and at length radiate out into 
the cortical substance, where they form loops by uniting one with another. 
This is seen most distinctly where the white and reddish gray substances 
are united together, or in the yellow substance at the periphery of the 
liemis|)heres of the cerebrum and cerebellum. 

The elements of the ganglia of the nerves in the higher animals, and in 
the human subject, have been ascertained by Valentin to be globules of 
considerable size, with an interior nucleus, and in the circumference of this 
anoliier smaller luicleus, and also spots of pigment on their surface. One 
or more fasciculi of fibres which enter the ganglion form within it a plexus, 
the fibres undergoing a different arrangement, and ag^in issue from it; while 
single fibres, or fasciculi of fibres, form an interlacement around the glo- 
bules of the ganglion. The fibres which form this interlacement come off 
from the trunk of the nerve and join it again, 'i'his description applies to 
the ganglionic globules generally. 

"The gray substance of the brain and spinal cord is, according to Valentin, 
formed wholly of the same globules as the ganglia of vetebrate animals. The 
appearance of minute granules is produced by the disintegration of the oricrinal 
globules, which are vrry soft. The only circumstance in which the globules of 
the gray substance of the brain differ from those of the ganglia, is that the cel- 
lular tissue which invests the former is less firm. In thewhite substance of the 
brain there are, according to Valentin, no globules or granules; the appearance 
of granules in it is produced by the nervous fibres being broken up. On the 
quantity of the deposit of gray globules depends the degree in which certain 
parts of the brain differ in color from the while or fibrous substance: where the 

Miiller's Elements of Physiology, 129 

primitive fibres are in the greatest number, the color is whitish gray; where they 
are less abundant, it is reddish gray: the darker colour of certain portions of the 
brain depends on a pigment deposited on the globules." 

Rolando has discovered two kinds of gray substance in the spinal cord. 
What is commonly known as the gray substance of the spinal cord, con- 
tains the great ganglionic globules above desbribed, together with numerous 
fibres. At the posterior part of the posterior cornua of this substance runs 
a, line of perfectly gray matter, which contains corpiiscules similar to the 
red particles of frog's blood. The continuation of this matter in the me- 
dulla oblongata, where it comes to the surface, has the same structure. 

Certain processes are seen, under favorable circumstances, to issue here 
and there from the large globules of the gray substance of the brain and 
ganglia. The fibres of the ganglionic globules observed by Remak, have 
some similarity with the delicate gray filaments which he has detected in 
ganglionic nerves; and if, according to Muller, the latter filaments, which 
form the gray fasciculi of the sympathetic, are organic nerves, it becomes 
in some degree probable, or at lea&t possible, that this is the origin of the 
gray fibres of the organic nerves. 

On the distribution of the white and gray systems of fibres in the cere- 
bro-spinal and sympathetic nerves, Professor Muller remarks as follows: 

" We have already mentioned that the cerebro-spinal nerves contain some 
fasciculi of gray fibres, and that the sympathetic contains likewise some few 
fasciculi of white fibres. We have suggested as probable, that the gray fibres, 
which have a peculiar structure, derive their origin from the ganglionic globules 
which are so frequent in the ganglia of the sympathetic, but which are present, 
though in less number, at those parts of the cerebro-spinal nerves, where the 
fibres of the sympathetic enter more largely into their composition, as at the 
angle of the facial nerve, where it is joined by the vidian, and in the second and 
third branch of the nervus trigeminus. We see, therefore, that the sympathetic 
differs only in a relative manner from the other nerves. The minted cerebral 
and spinal nerves contain chiefly fasciculi of sensitive and motor fibres, and a 
few fasciculi of gray fibres, which have a tendency to the formation of ganglia: 
the synn pathetic, on the contrary, contains a few sensorial and motor elements, 
derived from the posterior and anterior roots of the mixed nerves, and consists 
chiefly of gray organic fibres, corresponding with its distribution to parts which 
serve principally for the production of chemical changes in the lluids of the 
body. Hence the frequency of ganglia in the sympathetic nerve; while in the 
cerebro-spinal system of nerves, if we except the regular ganglia of the poste- 
rior roots, ganglia are rare, occurring only where there is a considerable inter- 
mixture of gray fibres from the sympathetic." 

Professor Miiller arranges the ganglia into three classes — 
1. Ganglia of the posterior roots of the spinal and cerebral nerves, the 
ganglion of the larger portion of the nervus trigeminus, that of the vagus, 
the ganglion jugulare superius of the glosso-pharyngeal nerve; and, lastly, 
the ganglion on the small posterior root of the hypoglossal nerve. These 
ganglia have the common character of belonging to nerves of sensation. 

" The structure of the ganglia of this class is not essentially different from 
that of the ganglia of the sympathetic; but we see in them more distinctly the 
pencil of fibres passing through unchanged between the globules of the proper 
substance of the ganglion. The special function of the gangliaof the sensitive roots 
is not yet known. Perhaps ihey may give rise to the organic fibres of the sympa- 
thetic, which these ganglia would then connect with the posterior columns of 
the spinal marrow. The sensitive and motor white fibres of the sympathetic 
are connected with the posterior and anterior roots of the spinal nerves."-^ 

130 Reviews. 

"The g-anglia of the sympathetic itself, however, appear to be, at all events, a 
principal source of the organic fibres. The lateral cords of the sympathetic are 
proportionally much whiter than the branches of the great abdominal ganglia. 
The facts which we have at present considered, do not enable ns to decide 
whether an increase in the number of fibres takes place in the ganglia of the 
sensitive roots, and in the Gasserian ganglion. The white fibres pass through 
with merely a change of arrangement — thus far is certain. But gray fibres may 
arise from the ganglionic globules, since it is indeed a known fact that gray 
fasciculi arise in the Gasserian ganglion and accompany the branches of the 
nervus trigeminus." 

2. Ganglia of the sympathetic nerve. Professor Miiller remarks, that 
if a miilli[)licalion of fibres takes place in any ganglia, it is most likely to 
be in those of tlie sympathetic, and it is at least difficult to suppose that 
all the primilive fibres of the abdominal plexus are contained in the roots 
of the sympathetic from the spinal nerves. But if this multiplication does 
take place, it can affect only the delicate gray organic fibres; for the ordi- 
nary primitive fibres of the nerves are known to pass unchanged through 
the ganglia of the sympathetic, as they do through those of the first class. 

3. Ganglia of the cerebro-spinal nerves at the points where they unite 
with branches of the sympathetic. These are the ganglion petrosum nervi 
glosso-pharyngei, the intumescentia gangliiformis on the angle of the facial 
nerve, the ganglion spheno-palatinum on the second branch of the nervous 
trigeminus, the ciliary ganglion, and perhaps, also, the otic ganglion, and 
some others. Professor Miiller supposes that the reason why the union 
of fibres of the sympathetic with cerebral nerves is attended, in the above 
instances, with the formation of a ganglion, while no ganglion is formed 
at any one of all the numerous points of origin of the sympathetic from 
the cerebral and spinal nerves, is because that at the points enumerated 
branches of the cerebral nerves coming from the brain are not given off to 
the sympathetic, but that branches of the latter here join the cerebral 
nerves; the fibres thus added to the nerves being continued then, not 
merely to the brain, but in the peripheral direction with the cerebral nerve. 
If this supposition, he remarks, were of general application, we should 
know when a cerebral nerve, not at its root, but in its further course, pre- 
sented a swelling corresponding with the point of union with the sym- 
pathetic, that the fibres of the sympathetic joining it did not come as roots 
of the latter from the cerebral nerve, but were fibres of the former going to 
join the latter. 

" Should the above view be confirmed, then," the Professor remarks, " the 
ganglia in question — those just considered — will no longer be a distinct class, 
but will belong to those of the sympathetic system, and will be included in the 
second class. The sympathetic system would, in that case, have three kinds of 

" 1. The ganglia of the middle line, or the plexus-like ganglia of the abdomen. 

"2. The ganglia of the lateral cords, lying at the points of juncture of the 
roots of the sympathetic. 

"3. The ganglia of the sympathetic, which are situated at the points of junc- 
tion of this nerve with the cerebral nerves, and which modify the properties of 
the latter, not those of the sympathetic." 

The second chapter treats of the excitability of the nerves. The action 
upon the nerves of mechanical and chemical stimuli, of temperature and of 
electric stimuli, are very fully considered; all of which stimuli, however dif- 
ferent they may be from each other, are shown to act in the same manner 

Miiller's Elements of Physiology, 131 

upon the nerves — namely, by exciting them; the most different causes 
produce the same effect, because that on which they act possesses but one 
kind of excitable force, and because agents in themselves the most different 
act here by virtue of the same quality, that of stimuli. We are unable to 
follow the author in his interesting remarks upon the effects resulting from 
the excitement of the several classes of nerves by different kinds of stimuli; 
the subject of the action of electric stimuli being, however, of peculiar in- 
terest, we shall present the general conclusions he has deduced in relation 
to it from an extensive series of experiments. 

Electricity, according to Professor Miiller, produces in the nerves the 
same phenomena of reaction that follow the application of mechanical and 
chemical stimuli. 

" Mechanical violence^ as in striking the ulnar nerve at the elbow, g-ives rise 
to the sensation of a shock; the sarae sensation is felt when an electric discharge 
is passed tlirough a nerve. This effect must be regarded merely as a sensation; 
a mode of reaction of the nerves, with which its cause, the electricity, must not 
be confounded. The sensation of the blov/ or shock is not the action of the 
electricity, but is the action of the nerve which becomes the seat of this sen- 
sation whenever a violent change is produced in the state of its component 
parts, whether this change is produced by animal or mechanical stimuli or by 

The author sets out with the proposition, that in the discovery of gal- 
vanic electricity, we have not beconie acquainted with a Huid similar in 
its action to the nerves, but merely with a n6w stimulus of the nerves in 
addition to those already known. The production of muscular contraction 
by galvanism, as well as the particular circumstance under which it takes 
place, is noticed. The fact tliat the nerves do not act as mere conductors 
of electricity of the galvanic circle, is proved by the result of direct ex- 
periment, and in the same manner it is shown that the stimulus of gal- 
vanism excites in all the organs of sense different sensations, in each 
organ, namely, the sensations proper to it. 

Having examined the immediate effect of stimuli upon the nerves, the 
changes produced in the excitability of the nerves by these agents are next 
considered: namely, diminution and exhaustion. There are, according to 
our author, no renovating stimuli, substances wliich have the power of 
increasing the nervous power. There are stimulants, it is true, in abun- 
dance; but, he remarks, they can strengthen the nerves only by promoting 
the reproductive process of nutrition in them. 

The narcotics which, while they stimulate, seem to produce a change 
of composition in the nervous matter, are denominated by Professor Miiller, 
alterant stimuli. 

It is, according to him, by their property of changing the composition 
of the nervous matter that narcotics, in small doses, are useful in cases of 
paralysis, where tirey either remove slight material changes in the nerves, 
or produce such a change as enables nature to effect the cure. A more 
violent action of the alleranlia nervina, or narcotics, is immediately de- 

''The most usual mode of action of narcotic poisons, when they paralyse the 
sensitive and motor powers of the nerves, is by being absorbed into the blood, 
thence acting in the capillary vessels on the brain, spinal marrow, and nerves. 
Their second mode of action, which is less rapid and more circumscribed, is by 
destroying locally the nervous power." 

132 ' Reviews. 

After enumerating a variety of experiments tending to prove that the 
rapid general action of local poisoning is not effected through the medium 
of the nerves, but that the poison enters the blood, and is with it distri- 
buted to all the organs of the body, the author adds, that it is likewise 
susceptible of proof, that 

"The general symptoms of poisoning are principally owing to the action of 
the blood, impregnated with the deleterious substance, on the central organs of 
the nervous system: 

" 1. After death produced by poisoning, the nerves and muscles are found to 
retain their irritability for a considerable time. 

" 2. Ligature of the arterial trunk of an extremity does not exempt the latter 
from participating in the general effects of a poison subsequently administered, 
of which the action produces muscular spasms." 

While, however, it is certain that the general effects of poisoning depend 
on the absorption of the substance into the blood, it is equally true that 
the narcotic poisons produce, also, a local influence. Thus a portion of 
the trunk of a nerve may be paralysed by the application to it of some 
narcotic — the influence of which latter will not be propagated along the 
trunk to the branches of the nerve. Nor does the narcotic action react 
from a particular point of a nerve on the brain. 

The second chapter concludes with some observations in evidence of the 
dependence of the nerves on the brain and spinal marrow. 

The third chapter treats of the active principle of the nerves. The 
remarks of the author under this head are chiefly directed to expose the 
falsity of an opinion which a short time since was entertained by a majority 
of the leading physiologists, and is still adopted by many, namely, the 
identity, or at least the similarity, of the nervous principle and the galvano- 
electric current. The arguments urged by Professor Miiller to disprove 
this opinion are as follows:— 

"The neurilema and the surrounding parts being moist, electricity would not 
remain insulated in the nerves were it in action in them. It has mdeed been 
imagined that the nerves have an insulating property. But the neurilema itself 
is an excellent conductor of the galvanic fluid, and the nerves, as we shall show, 
have not a greater conducting power than other moist animal textures; for the 
galvanic current does not necessarily follow the ramifications of the nerves, it is 
only the nervous principle which takes that 'course. The galvanic current is 
conducted off from the nerves by the neighbouring tissues as readily as it is 
conducted by the nerves themselves, if a more direct course to the pole is thus 
eflfected. The passage of the nervous principle again is interrupted by a liga- 
ture, while this has no effect on the transmission of the galvanic fluid. 

" Electricity is known by the bodies which insulate it, and which are con- 
ductors of it; these are its sole and certain tests, and, in respect to them, the 
nervous principle differs from it, and consequently cannot be identical with it. 
Other proofs, however, derived from properties of the nervous principle already 
alluded to, may be adduced: 

" 1. When both poles of a galvanic battery are applied to a nerve, so that a 
galvanic current is transmitted through its thickness, the muscle to which it is 
distributed contracts, not because the galvanism reaches the muscle, but because 
the galvanic current, passed transversely through the nerve, affects it in the 
same way as mechanical violence, or the application of heat or caustic potash, 
and stimulates its motor power, the action of which is propagated only in the 
peripheral direction. 

"2. But if one pole is applied to the nerve, the other to the muscle, the galvanism 
does not fly transversely through the nerve, but from one pole to the other m a 

Miiller's Elements of Physiology. 133 

line from the nerve to the muscle^ and the effect is the same as if both poles had 
been connected with the muscle. Here the excitability of the nerve is acted on 
in its whole course to the muscle. 

"3. If the nerve be bruised, or tied with a ligature, between the point where 
both the wires are applied and the muscle, no contractions of the latter are ex- 
cited. The galvanic fluid passes transversely through the nerve, as in the first 
case, but the action of the nervous principle is interrupted by the mechanical 
injury or ligature. 

*' 4. If, on the contrary, the poles be applied, one above and the other below 
the injured spot or ligature, the galvanic fluid is conducted through it with per- 
fect facility, and, stimulating the lower part of the nerve, gives rise to muscular 

"5. Nerves, even when perfectly dead, are still, like all moist animal tex- 
tures, capable of conducting the galvanic fluid, though they have lost the power 
of exciting contractions in muscles. 

'* 6. Lastly, the experiments of myself and Dr. Sticker have shown that, 
when the vital influence of the nerves on the muscles has been interrupted for 
any considerable period, the stimulus of a simple galvanic circle is incapable of 
exciting their contractions." 

Professor Mliller conceives that the conclusions which must be drawn 
from the considerations which he has detailed in the chapier under con- 
sideration, are: — 

" 1. That the vital actions of the nerves are not attended with the development 
of any galvanic currents which our instruments can detect. 2. That the laws 
^f action of the nervous principle are totally different from those of electricity. 
3. To speak, therefore, of an electric current in the nerves, is to use quite as 
symbolical an expression as if we compared the action of the nervous principle 
with light or magnetism. Of the nature of the nervous principle, we are as igno- 
rant as of the nature of light and electricity; but with its properties we are nearly 
as well acquainted as with those of light and other imponderable agents. How- 
ever much these various principles differ from each other, the same question 
applies to all, namely: are their effects produced by currents of an imponderable 
matter travelling through space, or by the undulations of a fluid 1 Which theory 
be correct in the case of the nervous principle, is at present a matter not affect- 
ing the study of the laws of its action, just as the laws of optics must remain 
the sariae, whatever theory of the nature of light be adopted." 

The second section treats of the nerves of sensation, the nerves of motion, 
and the ortranic nerves. In the first chapter, the experiments which esuiblish 
the correctness of Charles Bell's theory of the sensitive and motor roots of 
the spinal nerves are detailed. Important and interesting as these experi- 
ments are, an analysis of them, on the present occasion, will not be necessary. 

The sensitive and motor properties of the cerebral nerves, are considered 
in the second chapter. 

Professor Mliller arranges the cerebral nerves into three classes. 1. 
Nerves of special sense: the olfactory, optic, and auditory. 2. Mixed 
nerves >with double roots: the trigeminus, glosso-pharyngeus, vagus cum 
accessorio, and in several mammalia, the iiypo-glossus. 3. Single rooted 
nerves: for the most part of motor function, which are either themselves 
entirely motor, and receive sens'iiive fibres from other nerves, or which, if 
their roots contain sensitive fibres, still cannot be classed with the double 
rooted spinal nerves. These are the oculo-motorius, the irochlearis, the 
abducens, and the facial nerve. 

Of the mixed cerebral nerves, according to MUller, the first and second 
divisions of the nervus trigeminus, which arise wholly from the ganglion 
of the portio major, are probably purely sensitive. 'J'he third division, 
No. LI.— May, 1840. 12 

134 Reviews. 

which is formed in pari of the portio minor, and receives another portion 
of its fibres from the Gasserian ganglion is both motor and sensitive. 

The glosso-pharyngeal nerve, the author describes as having two 
roots, one of which has a ganglion, and as possessing both sensitive and 
motor powers. In a note, however, the translator adduces the experi- 
ments of Dr. J. Reid, which, if perfectly accurate, prove that the glosso- 
pharyngeal nerve is really a nerve of sensation only. 

From the ganglion which the vagus nerve forms at the point where it 
passes through the foramen lacerum, it presents, according to the author, 
every resemblance to the sensitive root of a spinal nerve, and, as immedi- 
ately after its exit from the foramen, it is joined by a portion of the acces- 
sory nerve, it is, he concludes, in the present state of our knowledge, very 
natural to suppose that the vagus, in fact, derives the motor fibres, which 
are distributed in its branches to the larynx and pharynx, from the acces- 
sory nerve. 

" Goerres, indeed, had likened the oriorins of the vagus and spinal accessory, 
to the two roots of spinal nerves, even before the discovery of the properties of 
their anterior and posterior roots. The same idea has been more recently 
adopted by Professors Arnold and Scarpa, who. have compared the vagus to a 
posterior, the spinal accessory to an anterior root; and Bischoff has carried it 
out, and adduced new arguments in support of this view." 

The hypoglossal nerve, Mayer has discovered to possess in some of 
the mammalia, a small posterior root, with a ganglion, but in the human 
subject it has merely a motor root. 

The third, fourth, and sixth ocular nerves, according to Professor 
Mliller, have some sensitive endowment, although it is uncertain whence 
they derive the fibres by which they are endued with this sensitive power. 

The facial nerve, or portio dura of the seventh nerve. Professor Mliller 
describes as both motor and sensitive. — The principal source of its sensitive 
power, is described as arising from the union with it, in its course through 
the Fallopian aqueduct, of a branch of the vagus. 

The sensitive and motor properties of tlie ganglionic nerves, is the sub- 
ject of chapter third. While Bichat, Dupuy, Wutzer, Magendie, and Lob- 
stein, deny to the sympathetic, the property of conveying sensations, 
Flourens, Brachet, Mayer, and E..H. Weber, together with Mliller, on the 
contrary, contend that the ganglionic nerves, are to a certain extent sensitive. 

"The sensibility of the parts supplied by the sympathetic is, however, far 
more feeble and indistinct than in other parts, for we seldom feel in the stomach 
the very cold or hot food which we swallow: substances too, which are strong 
stimulants of the skin, such as mustard and horse-radish, are rarely productive of 
sensation in the parts furnished with sympathetic nerves; it requires very stronfr 
impressions to excite the whole sensitive power of these parts in as powerful a 
degree as can be done in other organs. This peculiarity has been explained on 
the hypothesis of Reil, that the oranglia have the nature of half-conductors, pre- 
venting the transmission of weak impressions, and allowing the transmission of 
such only as are the effects of very intense irritation. Although this view cannot 
be strictly demonstrated to be correct, yet it is apparently favoured by an obser- 
vation of Brachet, relative to the effects of irritation of the thoracic ganglia of 
the sympathetic in a living sheep. Brachet states, that having divided the 
costal cartilages on the right side near the sternum, he held the lung towards the 
sternum, and then saw the thoracic ganglia of the sympathetic at the sides of 
the spinal column. When he pricked the ganglia, or the cord of the sympa- 
thetic between them, he perceived no signs of pain; but, when he irritated one 

Miiller's Elements of Physiology. 135 

of the branches of communication between the sympathetic and the spinal 
nerves, pain was instantly manifested: this he witnessed in repeated experi- 
ments. He also observed, that ganglia, which at first appeared to be devoid of 
sensibility, became sensible after frequent irritation." 

The (Ganglionic nerves have, also, according to the observations of Pro- 
fessor Miiller a motor, though involuntary, influence on the parts which 
they supply. He has proved by experiments performed in conjunction 
with Dr. Slicker, that the contractile power of the muscles, is the result 
of a reciprocal action between them and the nerves, and is not a property 
of the muscles tliemselves, as Haller supposed. Humboldt, Burdach, 
Wulzer, and Miiller have, likewise, shown by direct experiment, the motor 
influence of the ganglionic nerves upon the muscles. 

The author enters into an examination of the composition of the sympa- 
thetic nerve. He describes it as containing sensitive, motor, and organic 

"The peculiarity of the sympathetic," he remarks, "seems to consist merely 
in the mode in which it assembles its radicle fibres, and again distributes them in 
the peripheral direction. The radicle fibres run, namely, for a certain extent in 
the principal cord of the sympathetic, before being given off in the branches; and 
thus is produced an apparently continuous cord from the superior cervical gan- 
glion to the ganglion coccygeum. I say, apparently continuous; for there are no 
facts to justify the conclusion, that the fibres coming from the first cervical 
ganglion are continued to the inferior extremity of the cord. The fibres leave 
the longitudinal cord in the same order as they enter it: the first form the cardiac 
nerves, the next the splanchnic, the next the renal, the aortic and so on. But 
this is not really a peculiarity of the sympathetic. It is a structure common to 
many other nerves; the spinal nerves, for example, have arches of communica- 
tion between each other, and thus form continuous cords, extending a consider- 
able distance, from which are given off in succession, the nerves which had pre- 
viously joined them. The nerve called the ramus descendens noni, again, is 
partly formed by the superior spinal nerves; on the other hand, it sometimes 
happens that the cord of the sympathetic, is interrupted here and there between 
the points where the radicle fibres join it, or is extremely thin, as in serpents." 

"It being shown that the sympathetic regularly receives fasciculi of motor 
and sensitive fibres from the spinal nerves, as its motor and sensitive roots, the 
existence of a similar relation between it and those cerebral nerves, which are 
analogous to the spinal nerves, in having double roots, becomes very probable. 
The hypo-glossal, vagus, and glosso.pharyngeal nerves do in fact give roots to 
the superior cervical ganglion, and thus to the cord of the sympathetic. We do 
not, however, mean to assert that all the fibres of these cords are motor and sen- 
sitive, for such is not the case. The ganglionic or sympathetic nerve, then, 
receives roots of sensitive and motor properties from the cerebral nerves which 
we have named. It likewise receives a similar root from the great spinal nerve 
of the head, the nervous trigeminus. The vidian nerve is, at least in part, a 
root given off to the sympathetic." 

The system of gray or organic fibres, and its properties, are treated of in 
chapter fourth. The observations of Retzius, Van Deen, Remak and M illler, 
have demonstrated the existence in the cerebro-spinal, as well as in the gan- 
glionic, of gray organic fibres. The ganglionic nerve contains the greater 
number of these fibres, which gives it a proportionally grayer colour; while 
in the cerebro-spinal nerves, the gray fibres are few in number, and are 
seen as gray fasciculi, lying in the larger mass of white fasciculi. 

According to Remak, the gray fibres are much more minute than the 
white, perfectly homogeneous, that is to say, not composed, as far as can 
be distinguished with the jnicroscope, of a tube and contained portion; 

136 Reviews. 

Ihey are so pale and transparent, that unless a strong- shadow be thrown on 
ihern, ihey are not visible; lastly, a completely characteristic appearance is 
produced by the small roundish or oval bodies, which here and there beset 
their surface. It is rendered very probable by the result of the long and 
patient investigations of Remak, thattlie organic fibres arise from the caudal 
prolongations of the globular bodies of the ganglia. Hence the organic 
fibres may undergo an increase in the ganglia, and the greater prevalence 
of gray fibres in the peripheral portion of the ganglionic system, while 
the main lateral cords of the sympathetic are more nearly white, is in 
favour of this view. 

"The ganglia must, therefore, in fact, be regarded as the central organs or 
brains of the system of organic fibres, while the sensitive and motor fibres of 
the ganglionic nerves are derived from the brain and spinal cord. From the 
ganglia arise also the organic fasciculi, which accompany the cerebro-spinal 

" Although the organic fibres do not take their rise in the brain and spinal 
cord, yet it is probable that they are connected with the spinal cord, through 
the medium of the communicating branches betvv^een the sympathetic and 
spinal nerves, so as to derive an influence from the central organs of the cerebro- 
spinal system, for Remak several times succeeded in finding organic fibres in 
the roots of the spinal nerves generally, as well as in the rami communicantes. 
What relation the ganglia of the posterior roots of the spinal nerves bear to the 
system of organic fibres is still uncertain. From the similarity of their struc- 
ture to that of other ganglia, it might be supposed that they also serve for the 
origin of these fibres. This, however, would not explain their constant pre- 
sence on the posterior roots of the spinal nerves. If, as has been frequently 
imagined, ganglia have an insulating influence on the fibres which traverse 
them, considering these fibres in the light of conductors, then the ganglia of the 
posterior roots of the spinal nerves, might have the ofiice of deadening the vio- 
lence of the impression communicated by sensitive nerves to the spinal marrow, 
and of thus preventing the excitement of the spinal marrow to the production of 
reflex motions, which do not take place except when the impression on the sen- 
sitive nerve has a certain degree of violence. This would agree too with the 
indistinctness of the sensations in parts supplied by ganglionic nerves of which 
the ganglia are more frequent. But all this is a speculation resting on a mere 

The function of the gray organic fibres is, agreeably to the views of our 
author, to regulate the vegetative processes of the body — nutrition, secre- 
tion, &c. 

The subject of chapter fifth, — the motor, sensitive, and organic nerves, in 
the nervous system of the invertebrata, — though one of great interest, we 
shall be obliged to pass over without further notice. This brings us to 
the third section of book the third, which treats of the mode of propaga- 
tion of nervous action in the diflferent nerves. After noticing the two lead- 
ing opinions entertained as to the natuie of nervous action, whether it be 
due, namely, to the passage through the nerves of an imponderable matter, 
or to oscillations or vibrations, the author remarks: 

"In comparing the different parts of the nervous system, we find conductors 
and excitors of nervous action. The conductors are the nerves; the excitojs, the 
central organs. The nerves, however, have not merely the quality of conduc- 
tors, for, after separation from the brain, they are for a certain time capable of 
exciting, when irritated, contractions of the muscles; but, after they are thus 
cut off from communication with the central organs, they gradually lose this 

Muller's Elements of Physiology, 137 

Reference is made to the several estimates of the velocity of nervous 
action, and an account is given of the curious facts detailed by M. Nicolai 
of Manheim, which might incline some to believe that the velocity of 
nervous action is different in different parts of the nervous system, and 
even in different individuals; an inference which Professor Miiller has 
shown to be fallacious even admitting that the facts referred to are perfectly 
well established. 

We shall confine ourselves to a mere enumeration of the laws of the trans- 
mission of nervous influence in motor nerves, as laid down by Professor Miil- 
ler in chapter one, without attempting to present to our readers an abstract of 
the facts and reasoning by which the correctness of these laws is established. 

"1. The motor influence is propagated only in the direction of the nervous 
fibres going to the muscles, or in the direction of the ramification of the nerve; 
never in a retrograde course." 

"2. The application of mechanical or galvanic irritation to a part of the fibres 
of a nerve, does not affect the motor power of the whole trunk, but only that of 
the portion insulated from the rest, to which the stimulus is applied." 

"3. A spinal nerve entering a plexus, and contributing with other nerves to 
the formation of a great nervous trunk, does not impart its motor power to the 
whole trunk, but only to the fibres which form its continuation in the branches 
of that trunk. — This is shown by experiments of Van Deen, myself, and Kron- 

The following is the author's explanation of the cause of associate or 
consensual movements — that is, those movements which, contrary to our 
will, accompany other voluntary motions. Examples of true consensual 
movements are very frequent, even in the healthy state of the body. — 
Thus, when we endeavour to contract one set of muscles, we induce motion 
in another set of muscles that we had not willed to move. 

*'The primitive fibres of all the voluntary nerves being at their central ex- 
tremity all spread out in the brain to receive the influence of the will, we may 
compare them, as they lie side by side in the organ of the mind, to the keys of 
a piano, on which our thoughts play or strike, and thus give rise to currents or 
vibrations of the nervous principle in a certain number of primitive nervous 
fibres, and consequently to motions. From the conducting power of the cerebral 
substance at the origin of the nervous fibres, however, those which are contigu- 
ous to each other must be liable to be affected simultaneously, and the influence 
of volition will with difficulty be confined to single fibres. By repeated exer- 
cise, this faculty of insulating the influence of the will is acquired; that is to 
say, the more frequently a certain number of nervous fibres are exposed to that 
influence, the more prone do they become to obey it independently of other sur- 
rounding fibres; or, in other words, certain paths for the more ready transmission 
of the cerebral influence are gradually developed. This faculty of insulation of 
the influence of volition is seen to reach the highest degree of perfection in cer- 
tain arts, for example, in the use of musical instruments, particularly of the piano. 

** All associate movements have their source in the brain itself — they can not 
be attributed to a communication between the primitive fibres in the motor 
nerves— for, in the first place, the primitive fibres do not communicate with 
each other, and secondly, irritation of a portion only of a great nervous trunk 
never influences the rest of the nerve, but is propagated only to those branches 
of it which are formed of the fibres irritated. 

''The associate movements cannot, moreover, be ascribed to the action of the 
sympathetic nerve, which maintains communications neither between different 
portions of a motor nerve, nor between the corresponding nerves of the two 
sides of the body — such communications are affected solely by the brain and 
spinal cord." 


138 Beviews. 

The following are laid down by professor Miiller (chapter 2) as the laws 
of the propagation of the nervous influence in the sensitive nerves: 

*' 1. When the trunk of a nerve is irritated the sensation is felt in all the 
pans which receive branches from it; the effect is the same as if all the ultimate 
ramuscules had been irritated." 

" 2. The sensation produced by irritation of a branch of a nerve, is confined to the 
parts to which that branch is distributed, and, generally, at least, does not affect 
the branches which come off from the nerve higher up, or from the same plexus." 

"3 When, in a part of the body which receives two nerves of similar function, 
one is paralysed, the other is inadequate to maintain the sensibility of the entire 
part; on the contrary, the extent to which the sensibility is preserved corres- 
ponds to the number of the primitive fibres unaffected by the lesion." This is 
illustrated by the history of local paralyses, 

" 4. When different parts of the thickness of the same nerve are separately 
subjected to irritation, the same sensations are produced as if the diflferent ter- 
minal branches of these parts of the nerve had been irritated." 

" 5. The sensations excited in the minute elementary fibres are transmitted 
from the surface to the brain without being communicated to the other fibrils of 
the same nervous trunk. This is a necessary inference from the facts and laws 
already detailed." 

" 6. Although pressure on a nerve gives rise to sensations which are felt in the 
peripheral parts, yet a stronger pressure produces pain in the nerve itself at the 
point to which it is applied. — We experience this but rarely, as when we suffer 
violent blows on the ulnar nerve." "From the facts already detailed, and 
others that follow this would not be expected; and there seems to be something 
here with which we are unacquainted, but which is important in relation to the 
theory of sensations." " The direction which the pain takes in cases of neu- 
ralgia, namely, along the course of the nerves, appears, likewise, not to agree 
with the theory of sensations above proposed. It must, however, be remarked 
that neuralgic pains by no means constantly follow the course of the nerves. 
I have examined several cases of true neuralgia in Berlin, in which the pain 
did not pursue the course of the anatomical distribution of the nerves. Other 
facts are favourable to our theory. We are in want of information calculated 
to elucidate these apparent contradictions." 

" 7. When the extreme parts are completely deprived of sensibility by pres- 
sure on a nerve, or by its division, irritation of the portion of the nerve connected 
with the brain still excites sensations which are felt as if in the parts to which 
the peripheral extremities of the nerve are distributed." " Division of a nerve, 
. then, merely prevents the possibility of external impressions on the cutaneous 
extremity of the nervous fibres being felt; the impressions being no longer com- 
municated to the brain. But the same sensations which were before produced 
■by external impressions may arise from internal causes, as long as the primitive 
fibres of the trunk remain in connection with the brain or spinal cord." 

" 8. When a limb has been removed by amputation, the remaining portion 
of the nerve which ramified in it may still be the seat of sensations, which are 
referred to the lost part. — This is a fact known to all surgeons, and is subject to 
no exceptions." 

"9. The relative position of the primitive fibres of the nerves at their origins, 
and in the nervous trunks, is not altered by a change of the relative position of 
their peripheral extremities, and hence we find that, when the relation of the 
fibres at their peripheral extremity is changed, the sensations of which they are 
the seat are referred to the same spots as before. — This is exemplified in the 
phenomena observed when the peripheral extremities of nerves have their rela- 
tive position changed artificially, as in the transposition of portions of skin." — 
"Another phenomenon, perfectly similar in its nature to the foregoing, and expli- 
cable on the same principles, is that, when we cross the fore and middle fingers, 
and roll a small globular body — for example, a pea — between the opposed sur- 
faces of the fingers, these surfaces being those which in the natural state are 
turned from each other, we seem to feel two globular bodies." 

Mullei's Elements of Physiology. 

The author does not appear to be decided as to the cause of the radiation 
of sensations, or why one sensation should excite another, or why sensations 
in disease should extend to parts not actually affected — whether this pheno- 
menon is to be referred to the imperfect conducting power of the ganglia of 
the sensitive nerves not allowing feeble impressions on particular fibres to be 
propagated through them to the other fibres, confining them, hence, to the 
primitive fibres on which they v;ere originally made, but, ceasing to insulate 
the nervous fluid, when the impressions areiery energetic, conduct oflT a part 
of it to the other primitive fibres which pass through the ganglia, thus giving 
rise to the radiated or sympathetic sensations; or, whether these sensations 
are the result of the radiation of the irritation from the fibres primarily affect- 
ed upon the roots of other fibres in the brain or spinal cord, just as, in the 
production of the reflected motions, the impression conveyed to the spinal 
marrow by the sensitive nerves, is communicated to motor nerves; the 
only difference being, that, when the sympathetic sensations are produced, 
the radiation of the impression does not reach the motor nerves, but only 
the sensitive fibres arising from the surrounding part of the cord, or at least 
affects these at the same time with the motor nerves. He seems, how- 
ever, inclined to favor the latter explanation. 

"It must be remarked, however," he observes, "that if we explain the sympa- 
thetic sensations by such reflex action, we must presuppose that currents or 
oscillations can be propagated in the sensitive nerves in both directions — from 
the brain as well as towards it. It is not known whether this be possible, or 
whether the sensitive nerves can propagate their actions in the centripetal direc- 
tion only. It is interesting, therefore, to know that we can explain the phe- 
nomena, even though the sensitive nerves do not act in the centrifugal direction. 
"We have seen that the same sensation seems to be produced at whatever point 
of its length a nervous fibre is irritated, whether at its peripheral extremity, at 
its middle, or at its origin in the brain and spinal cord; and that this sensation 
is felt in the parts to which the nerve is ultimately distributed: the mere 'radi- 
ation' of an impression, therefore, from one sensitive nerve in the substance of 
the brain or cord, so as to affect the origins of other sensitive fibres, will be suf- 
ficient to produce sympathetic sensations. We know in fact that, in affections 
of the spinal cord, the sensations appear to be in the peripheral parts of the 
body; — thus inflammation of the spinal cord, is attended with violent pain in 
the limbs." 

The observations of Professor Mailer on the coincidence of several sen- 
sations, especially in reference to the identity or singleness of the sensa- 
tions experienced by the two optic nerves, are interesting, though not very 

According to Weber the difference in the accuracy with which individual 
impressions are distinguished, depends on the number, course, and mode 
of termination of the nervous fibres: in this opinion the author entirely 
coincides, merely remarking, that the greater or less facility for t'.e radia- 
tion of impressions in different parts of the brain and spinal marrow may 
have some share in the production of these differences. 

Professor Miiller has shown that there are only certain parts of the 
retina or optic nerve of the two eyes of which the sensations are identical, 
while the sensations of the others are not so. In reference to sensations, 
the two retinae must be regarded as included one within the other — so 
that all points of the two retinae which lie within the same degrees of lati- 
tude and longitude (the eyes being regarded as globes) are identical in their 
sensations, — all other points in the two retinas are opposed to each other. 

140 Reviews. 

or different, just as any two points in the retina of the same eye; — hence 
in double vision the impression is made in the two eyes upon points of 
the reiinee which do not correspond in their sensation. 

The author has shown that the fact of each root of the optic nerves, on 
leaving the commissure, not going to one eye solely, but to boih eyes, does 
not explain the cause of single vision. To explain this it would be requisite 
that each primitive fibre of each root, should, in the commissure, divide 
into two branches for the two optic nerves, so that the ideniical fibres of 
the two nerves might communicate with the brain at one point only, 
namely, by one radical fibre, which is not the case. 

Chapter third treats of the reflection in the production of motions con- 
sequent on impressions upon sensitive nerves. Professor Miiller main- 
tains that when impressions niade by the action of external stimuli on sen- 
sitive nerves, give rise to motions in other pans, these motions are never the 
result of the direct reaction of the sensitive and motor fibres of the nerves 
on each other, but that the irritation is conveyed by the sensitive fibres to 
the brain and spinal cord, and is by them communicated to the motor fibres. 

This law, wliich is of extreme importance in physiology and pathology, 
from its explaining a great number of phenomena in health and disease, the 
author proceeds to establish by the result of direct experiments. 

The views of Marshall Hall on the subject of reflected motions are 
examined and tested by facts. The leading ditFerence between these views 
and those entertained by ihe author will be readily perceived, by a refer- 
ence to the general proposition given above. 

From the facts adduced by Professor Miiller, he is led to admit as a 
general law, that, whenever general spasms are excited by local impressions, 
the phenomena depend on no other communication between the sensitive 
and motor fibres than exists in the spinal cord. In very many cases, how- 
ever, local irritations of ihe nerves give rise, not to general, but to local 
muscular spasms, in which case again, according to the author, the spinal 
cord is to be regarded as the bond of communication between the sensitive 
and motor fibres. The cases of this kind are the following: 

*' 1. The most simple is that in which the local irritation of the sensitive fibres 
being propagated to the spinal cord or brain, excites merely local spasms, — in 
those parts, namely, the motor fibres of which arise from the spinal cord, near 
the point where the sensitive fibres that are irritated also take their rise." 

"In muscles laid bare, the irritation applied directly to them acts also on the 
motor fibres distributed in them, and contractions of them are excited without 
any centripetal and centrifugal action of the nerve. But muscles which are 
invested by sensitive membranes, and are not themselves exposed to direct sti- 
mulus, can only be excited to action by irritation of the sensitive property of their 
investing membrane, the transmission of this irritation to the brain, and the cen- 
trifugal progagation of the motor influence from the brain to themselves." 

"2. The second case is, where the excitement of the sensitive nerves is entirely 
local, but the reflected influence from the brain more extended." Of this we 
have instances in the phenomena of coughing, sneezing, hiccough, vomiting, &c. 

"3. in the second kind of cases, the reflex action affects a large group of 
nerves — the respiratory nerves, and it is excited most frequently by irritation 
of a mucous membrane. When the irritation is more intense, however, the 
effects may be still greater, aff'ecling almost all the nerves of the trunk, if the 
irritation of the spinal cord becomes extensive. Thus, in severe cases of spo- 
radic cholera, sometimes cramps affect even the trunk." 

"4. In the reflected motions produced by violent impressions on the sensi- 
tive nerves of the skin, not of the mucous membranes, the respiratory move- 

Miiller's Elements of Physiology. 141 

ments are not sympathetically excited, but rather spasmodic contractions of the 
muscles supplied by the whole system of nerves of the trunk, without any 
spasmodic movements of respiration. Of the extreme decree of such an affec- 
tion we have instances in the epileptic convulsions from local affections of the 
nerves, and the traumatic tetanus from injury of a nerve." 

Professor Miiller agrees with Dr. Hall, that the reflected motions which 
occur after the loss of the brain, are no proof that stimuli applied to the 
skin are still able to excite true sensations in the spinal cord. — in these 
cases, the ordinary centripetal action of the nervous principle lakes place, 
as when sensations are produced; but here it does not give rise to sen- 
sations, since it is not communicated to the brain, the organ of conscious- 

"During life, also, in the state of health, many reflected motions are excited 
by irritations of membranes, which are not, as true sensations, communicated 
to the sensorium, but nevertheless produce strong impressions on the spinal 
cord; as for example, the irritation of the faeces or urine, exciting the contractions 
of the sphincters. But Dr. Hall goes too far in admitting that, in the healthy 
state, every motion which follows true sensation is voluntary, and that all irri- 
tations of sensitive parts which give rise to reflected motions are unattended 
with sensations — for the reflected motions of sneezing, coughing, and many 
others, are consequent on true sensations. The reflected motions, and the 
involuntary not reflected motions, must not be confounded with each other." 

Important and interesting as this subject is, in every point of view, our 
limits will not permit us to present a more extended notice of the author's 
views in relation to it — no analysis would, indeed, give to our readers a 
correct idea of the several details connected with the physiology of reflex 
motions as presented by Professor Miiller, and to multiply our quotations 
from the chapter before us would extend our review to an unreasonable 
length. * 

In the fourth chapter, the following important questions are discussed: 
Is the nervous principle, or force, of the motor fibres dilferentin its qualities 
from that of the sensitive fibres? or, are what are here called the motor and 
sensitive principles, actions of the same nervous principle, differing only in 
direction, being centrifugal in the motor, centripetal in the sensitive fibres? 
No satisfactory solution of these questions, according to the author, can be 
derived from the facts at present in our possession. There is no positive 
evidence that either the sensitive or motor nerves propagate nervous irritation 
in one direction only. There is one circumstance in particular, he remarks, 
which excites still greater attention in reference to the subject. 'I'his is the 
fact that, for the preservation of the excitability of the motor nerves, their 
communication with the central organs of the nervous system is necessary: 
this, in appearance, is in favour of all nerves, including the sensitive nerves, 
being equally dependent on the brain and spinal cord; in which case, how- 
ever^ there would be centrifugal emanations from the latter organs through 
the sensitive nerves. Future experiments, founded on well conceived 
ideas, or new discoveries, must decide the question. 

"The hypothesis of the circulation of the nervous fluid, or of its vibrations 
jn the two kinds of nervous conductors, is, however, for several reasons very 
improbable; for, since many nerves are sensitive only, these must either not be 
the seat of a circulation, or we must suppose agam that with their sensitive 
fibres they contain an equal number of fibres of centrifugal action, which do not 
give rise to motions, only because they do not terminate in muscles. Now, if 
we merely regard those motor and sensitive nerves which communicate by anas- 

142 Reviews. 

tomoses of their fasciculi, as in the instance of the facial and infra-orbital nerves, 
still less can we find in them the means for a circulation of the nervous fluid; 
for, in the first place, these anastomoses are not real communications of the pri- 
mitive fibres; and, secondly, an irritation excited in the facial nerve is proved 
by the experiments of Gaedechens not to be communicated through these anas- 
tomoses to the trunk of the infra-orbital nerve so as to excite pain. All these 
considerations teach us that the existence of a regular circulation of the nervous 
fluid from the brnin and spinal cord through the nerves back to the central or- 
gans cannot be demonstrated, and, in the present state of our knowledge, ap- 
pears very improbable." 

The following are the laws of action of the sympathetic nerve, and the 
propagation of impressions in it, as given by Professor Miiller, in chapter 
fifth; and first of the actions of the sympathetic nerve in involuntary 

" 1. All the parts subject to the influence of the sympathetic nerve are inca- 
pable of voluntary motion." 

" 2. 'I'he parts which are supplied with motor power by the sympathetic 
nerve still continue to move, though more feebly than before, when they are 
separated from their natural connections with the rest of the sympathetic sys- 
tem, and wholly removed from the body." 

"3. Hence all the parts endowed with motion, and supplied with nerves from 
the sympathetic, are, in a certain degree, independent of the brain and spinal 

"4. The central organs of the nervous system can, however, exert an active 
influence on the sympathetic nerves and their motor power." 

"5. The experiments of Dr. Philip tend to show, also, that distinct parts of 
the brain and spinal cord do not alone influence distinct parts of the sympathetic 
system, and of the motions dependent on it, but that the brain and the whole 
spinal cord, or every part of it, can exert an influence on the motions of the heart." 

"6. The movements excited in organs which are under the influence of the 
sympathetic nerve, by irritation applied tS them or to their nerves, are not tran- 
sitory and momentary contractions; they are either more enduring contractions, 
or they consist of a long continued modification of the ordinary rhythmic action 
of the organ: hence, in these organs, the reaction consequent on the irritation is 
decidedly of longer duration than the action of the stimulus." 

"7. The final cause of the involuntary motions, and the cause of their type, 
lies neither in the brain nor in the spinal cord, but in the sympathetic nerve 
itself. Even the influence of the ganglia is not necessary; the branches of the 
sympathetic going to an organ may be entirely removed, the twigs distributed 
to the substance of the organ only being left, and the motions will be maintained 
as before; the reciprocal action between the muscular fibres and these ultimate 
nervous twigs being apparently adequate to their production." 

" 8. Although, from the foregoing observations, it is certain that the extreme 
minute branches of the sympathetic have still the power of regulating the move- 
ments of the parts not subject to the will, yet it is not less true that both the 
brain and spinal cord, and the ganglia themselves, when in a state of irritation, 
exert an influence on these movements as long as the organs which are the seat 
of these movements are connected with them through the medium of the nerves. 
The brain and spinal cord are, however, also to be regarded as the source of the 
power of the sympathetic itself, which would without them become exhausted." 

"9. It results, from the facts already stated, that the sympathetic nerve is 
charged as it were with nervous power by the brain and spinal cord, which may 
be regarded as the sources of nervous influence, but that, when once charged, it 
continues to emit this influence in the manner peculiar to itself, even when the 
further supply is for a time diminished. This affords an explanation for a part 
of the phenomena of sleep." 

" 10. The influence of narcotics locally applied to the sympathetic nerve 
does not extend to the distant organs which the nerve supplies; but these organs 

Miiller's Elements of Physiology, 143 

may be paralysed by the direct narcotisation of the minute nervous fibrils which 
are distributed in them. In this respect the sympathetic resembles the cerebro- 
spinal nerves." 

"11. The laws of reflection, stated in the third chapter of this section pre- 
vail likewise in the actions of the sympathetic nerve. Strong impressions on 
parts supplied by the sympathetic nerve may be propagated to the spinal cord, 
and give rise to motions of parts which derive their nerves from the cerebro- 
spinal system." [Convulsions in children from intestinal irritation — the spas- 
modic action of the respiratory muscles in vomiting, excited by irritation in the 
intestinal canal, kidneys, uterus, &c., as well as all spasmodic affections from 
local irritations of the abdominal viscera, are explained by this law.] 

"12. Impressions on parts of which the nerves are derived from the sympa- 
thetic are communicated to the spinal cord and brain, and excite the motor in- 
fluence of the sympathetic nerve by reflection, although the reflex action is here 
less marked than in the case of the cerebro-spinal nerves." 

" 13. Reflected action of the sympathetic, from an impression communicated 
to the spinal cord by cerebro-spinal nerves, is a more frequent occurrence." 

"14. Can reflex phenomena be produced in the sympathetic nerve through 
the influence of the ganglia, and independently of the brain and spinal cord] — 
This interesting question cannot at present be decided." [[Volkman, from his 
experiments, denies that the ganglia have the power of giving rise to reflected 
motions — and Professor Miiller would seem also to incline to this side of the 

" 15. We are at present entirely ignorant as to whether irritation in one organ 
can, through the medium of the sympathetic, give rise to sympathetic move- 
ments in another; since all the sympathetic phenomena of this kind can be ex- 
plained on the principle of reflection from the brain and spinal cord." 

" 16. It is not proved, (and several facts have been observed which are op- 
posed to the belief,) that the ganglia can exert an insulating action, so as to 
impede the transmission of motor influence from the brain and spinal cord." — 
[Motor influence generally and not merely voluntary influence is here referred 

" 17. It is not certain that the ganglia are the cause of the parts supplied by 
the sympathetic nerve being withdrawn from the influence of the will." 

" 18. In certain organs, which are subject to the influence of the sympathetic 
and of the spinal nerves at the same time, a voluntary influence seems to be ex- 
erted only after the long continuance of a centripetal or sensitive impression. 
The urinary bladder presents this phenomenon." 

" 19. Many parts which are supplied by the sympathetic nerve, are, indeed, 
capable of involuntary motion only, but become associated with the motions of 
parts subject to volition, a part of the voluntary motor influence being commu- 
nicated involuntarily to them, just as in the associate motions of voluntary mus- 
cles. Of this an example is afforded by the iris." 

" 20. The motions of organs which derive their nerves from the sympathetic 
system, have a peristaltic type. The motions are progressive in a certain direc- 
tion, and the course which the motions take is dependent, not merely on the 
brain and spinal cord, but likewise on the nerves of the organs themselves. 
The cause of the peristaltic type is wholly unknown." 

Secondly, of the sensitive functions of the sympathetic nerve. 

" 1. The sensations in parts, the nerves of which belong to the sympathetic 
system, are faint, indistinct, and undefined; distinct and defined sensations be- 
ing excited in them only by violent causes of irritation." 

"2. The sensitive impressions received by the sympathetic nerve, although 
conveyed to the spinal cord, may not be perceived by the censorium, the organ 
of consciousness." 

"3. The impressions which give rise to reflex motions, when conveyed to the 
spinal cord by the sympathetic nerve, are, in most instances, not productive of 

144 Reviews. 

sensations; while those impressions which are received by cerebro-spinal nerves 
always give rise to sensations. This is true at least of the majority of cases." 

" 4. The ganglia of the sympathetic nerve do not prevent the transmission of 
centripetal actions in the sympathetic nerve to the spinal cord; they have not 
an insulating power over these centripetal currents." 

" 5. The ganglia are likewise not the cause of the impressions on the sym- 
pathetic nerve being unattended with true sensation. 

" 6. In many cases, irritation of a violent nature in organs supplied by the 
sympathetic nerve, gives rise to sensations in those parts; in other cases, the 
sensations in the parts affected, the irritation being less violent, are indistinct, 
while distinct sensations are present in other parts supplied with cerebro-spinal 

Of the first we have examples in inflammations of the intestinal canal 
and liver; of the second in the itching of the nose and anus in affections 
of the intestines; the itching of the glans penis in chronic diseases of the 
kidneys and bladder; in the pains of the upper extremities in diseases of 
the heart, and of the shoulder in hepatic diseases. 

"7. The secondary sensations in cerebro-spinal nerves, consequent on irrita- 
tion of branches of the sympathetic, occur especially at the extreme parts of 
the organs affected." 

"8. That the ganglia exert a reflex action in the production of the sympa- 
thetic sensations is not proved, and many facts are opposed to the idea of their 
having such a function."— "The theory of the reflected sensations excited by 
impressions on the sympathetic is still very obscure, and, at all events, the mode 
of accounting for them is a subject of doubt." 

Thirdly, of the organic functions of the sympathetic nerve. 

*' 1. When, in consequence of impressions on sensitive nerves, secretions take 
place in distant parts, the brain and spinal cord are probably the medium of 

"2. There prevails a consent of action between the different parts of a secre- 
ting membrane; thus, the state of one spot influences the condition of the whole 
extent of a mucous membrane. Here it is more simple to explain the pheno- 
mena by communication of the organic fibres with each other." 

" 3. A particular state of one organ, such as inflammation or a secreting ac- 
tion in it, sometimes causes the production of a similar stale in other parts. In 
this case we have an instance of reflected action of the organic fil)res of one part 
upon those of another." 

" 4. The ganglia appear to be the central parts from which the vegetative in- 
fluence is distributed to the different organs. Inflammation of the eye, and even 
the general phenomena of impaired nutrition, have been observed to follow in- 
jury of the first cervical ganglion. 

"5. This radiating influence of the ganglia appears to be in a certain degree 
independent of the brain and spinal cord, since the embryo may be developed 
while the brain and spinal marrow are destroyed. 

" 6. It appears, however, that the brain and spinal cord are the main source 
whence the power of the organic nerves is gradually renovnted, since certain 
affections of the brain and spinal cord, attended with paralysis, are likewise 
productive of atrophy. 

"In concluding our inquiry respecting the sympathetic nerve," Professor 
Miiller remarks, "we can but lament the obscurity in which much regarding it 
is involved: still, we think to have shown how investigations on this subject 
must be prosecuted; and that, by applying the laws governing the action of 
cerebro-spinal nerves to the sympathetic, much light has been thrown on the 
properties of this nerve, of which M. Magendie seemed to think so little known 
that he hesitated to regard it as a nerve." 

Muller's Elements of Physiology. 145 

From the foregoing series of quotations, which comprise a faithful sum- 
mary of the views of Professor Miiller on some of the most important, 
and, at the same lime, most obscure points of physiology, notwithstanding 
that their extent may be objected to by some, we believe that our readers 
will acquire a much more correct idea of the character of the work before 
us, than could be derived from any analysis it would be in our power to 

We regret that we are unable to notice the very interesting remarks of 
our author upon sympathies, presented in chapter sixth. He notices in suc- 
cession the sympathies of the different parts of one tissue with each other 
—of different tissues with each other — of individual tissues with entire 
organs — of entire organs with each other, and of the nerves themselves, 
namely, sympathies of nerves with the central parts of the nervous sys- 
tem — of the sensitive and motor nerves with each other — of the corres- 
ponding nerves of the two sides — oi motor nerves with each other — and 
of the sensitive nerves. Each of the particulars discussed in this chapter 
are of peculiar interest to the physician, from their direct bearing on all 
his pathological and therapeutical investigations. It would be impossible 
to present an accurate view of the author's observations in relation to the 
different sympathies, without quoting the greater part of the chapter, as he 
has observed the utmost conciseness in his detail of them. 

The fourth section of book third, is divided into two chapters, the first 
of which treats of the nerves of special sense, and the second, of the oc- 
ular, the fifth pair, the facial nerve or portio dura of the seventh, the glosso- 
pharyngeal, vagus, accessory nerve of Willis, the hypo-glossal or ninth 
pair, and the sympathetic. 

Sensation, according to Professor Miiller, consists in the communication 
to the sensorium, not of the quality or state of an external body, but of the 
condition of the nerves themselves, excited by the external cause. 

" We do not," he remarks, " feel the knife which gives us pain, but the pain- 
ful state of our nerves; — the probably mechanical oscillation of light is itself 
not luminous; even if it could itself act on the sensorium, it would be perceived 
merely as an oscillation; it is only by affecting the optic nerve that it gives rise 
to the sensation of light; — sound has no existence but in the excitement of a 
quality of the auditory nerve; — the nerve of touch perceives the vibration of the 
apparently sonorous body as a sensation of tremor. We communicate, there- 
fore, with the external world merely by virtue of the states which external in- 
fluences excite in our nerves." 

Hence the inaccuracy of all opinions founded on a supposed power of 
the nerves to perform the functions of each other — visionf smell, hearing 
and touch are the functions of separate nerves, which functions can in no 
instances be performed by other than their appropriate nerves. 

The present section contains an admirable exposition of the present gtate 
of our knowledge in relation to the physiology of the several nerves enume- 
rated above; an analysis of it would, however, be of very little interest to 
our readers, as, to be properly understood, the facts it sets forth must be 
studied in the form in which they are presented by the author. 

In section the fifth is embraced the physiology of the central organs of 
the nervous system. 

The activity oi all the functions of the nerves is determined. Professor 
Miiller remarks, (Chapter 1) by the central organs, partly under the 
influence of the mind, and partly independently of this influence. The 

No. LI.— May, 1840. 13 

146 Reviews. 

central organs connect all the nerves into one system, the sympathetic 
nerves not excepted. The only difference between the cerebro-spinal and 
the organic nerves in their relation to the central organs, being, that the 
former issue much more directly from them, while the organic nerves, 
although their fibres are, in company with the cerebro-spinal nerves, 
brought into communication with the brain and spinal cord, nevertheless 
have subordinate central organs in their ganglia and plexuses, from which 
the organic nervous influence more immediately emanates. The central or- 
gans are the exciters of the motor nerves, which conduct the motor influence 
of the nervous principle to the muscles, either constantly as in the case of 
the sphincters, or so as to produce intermittent rhythmic movements such 
as those of respiration, or the motor influence may. issue voluntarily from 
the sensorium commune of the central organs, this sensorium commune 
being subject to the spontaneous actions of the mind. 

" Impressions conveyed by the sensitive nerves to the central organs, are 
either reflected by them upon the origin of the motor nerves, without giving rise 
to true sensations, or are conducted to the sensorium commune, the seat of con- 

" Since the phenomena of reflection are not dependent on the sensorium com- 
mune, ])ut on the motor apparatus of the central organs, and since this apparatus 
continues in activity during sleep, these motions take place then as well as in 
the waking state, as is proved by cough from irritation of the trachea, and many 
other phenomena which occur during sleep." 

" The organic functions of the nerves are maintained in unimpaired force by 
the central organs of the nervous system. In this respect the same relation pre- 
vails between the sympathetic nerve and the central organs as with reference to 
the motions of parts subjected to the sympathetic. The action of the organic 
nerves in regulating nutrition and secretion is in a certain degree independent." 

" The nervous principle is generated and regenerated in the central organs." 
This is proved by experiments instituted by the author and Dr. Sticker. 

Chapter second, of the spinal cord. 

In its functions, the author remarks, the spinal cord so far agrees with 
the nerves that it propagates actions of the nerves which enter it, to the 
brain, just as the cerebral nerves communicate impressions made on them 
immediately to the sensorium commune, and that it communicates the in- 
fluence of the brain to the nerves arising from it, which thus receive 
through the medium of it, the cerebral influence, just as if they arose from 
the brain itself; in other respects, however, the spinal cord differs essentially 
from the nerves, in possessing properties which belong to it as a part of the 
central organs, and do not reside in the nerves. The spinal cord is to be 
regarded as the common stem of the nerves of the trunk. Hence lesions 
at any point of the cord induce paralysis of all those parts the nerves 
of which are given off from the cord below the seat of injury. The 
spinal cord does not merely represent in the brain all the nerves of the 
trunk in the aggregate, but, also, all the individual primitive fibres of these 
nerves singly, for affections of certain parts of the spinal cord interrupt 
the transmission of nervous influence to certain muscles of the trunk only, 
and lesion of certain parts of the brain paralyses only certain parts of the 
body. The primitive fibres in the spinal cord do not unite with each other 
but continue their separate course as in the nerves, so as to communicate 
isolated sensations to the brain, and to transmit from the brain the stimulus 
for isolated motions. The spinal cord may, then, be regarded as a trunk 
formed of nervous fibres, which sends out, anteriorly and posteriorly, in 

Miiller's Elements of Phydology, 147 

uninterrupted series, many millions of primitive fibres of motor and sensi- 
tive endowment to all parts of the body; ibe fibres being, between their 
origin and their peripheral termination, collected into numerous large and 
small fasciculi by means of cellular sheaths. 

The fact being established, that the anterior roots of the spinal nerves 
are motor, and the posterior sensitive, the inquiry naturally presents itself, 
whether the same difference as to motor and sensitive power prevails also 
in the spinal cord; do the motor and sensitive fibres run separately in the 
spinal cord to the brain? Facts drawn from cases of paralysis would seem 
to determine this question in the affirmative. Wliether tlie anterior 
columns of the cord are themselves motor, and the posterior mviely sensi- 
tive, throughout the whole length of the spinal cord, as maintained by Sir 
C. Bell and Magendie, it is impossible, according to Professor Miiller, to 
determine positively; no satisfactory facts bearing upon this point have 
been adduced either from experiment or disease. 

The fibres of the spinal cord pass through the medulla oblongata to 
reach the sensorium commune. 

The sensations produced by any afi'ection of the spinal cord, is referred, 
as in the case of the nerves to the extreme parts. 

The properties and functions which, according to the author, distinguish 
the spinal cord from the nerves, are as follows: 

1. The spinal cord has tlie property of reflecting sensorial irritations of 
its sensitive nerves upon the motor nerves; a property which no nerve 
separated from the central organs of the nervous system possesses. 

2. The spinal cord has the property of reflecting the action of sensitive 
nerves upon motor nerves, without itself perceiving the sensation. 

3. The spinal cord is a motor apparatus which, even when separated 
from the brain, and without any external stimulus, can excite automatic 
movements. The nerves, at all events those of the cerebro-spinal system 
have not this power, although the motor action of the sympathetic system 
in this respect resembles that of the spinal cord. 

4. "The spinal cord, although capable of exciting the motor nerves to automa- 
tic actions, nevertheless, in the healthy state, leaves a great part of the motor 
nerves, those supplying the muscles of locomotion more especially, in a quiescent 
state; while on many others it exerts a constant motor influence; maintaining 
thus constant involuntary contractions, which are arrested only by the spinal cord 
becoming paralysed. The motions of this kind are, 1. those of muscles which 
are also subject to the influence of the will as the sphincter ani; 2. those of mus- 
cles not subject to the influence of the will, as the sphincter vesicae urinae, the 
muscular coat of the intestines, the heart, &c. For these actions the spinal cord 
must possess a special apparatus more independent of the sensorium commune 
than that part of it wnich is engaged in the voluntary actions; though this can- 
not be demonstrated anatomically." 

5. The spinal cord has a great tendency to propagate a particular state 
of one part of it to other parts; in this property it difl'ers entirely from 
the nerves. 

6. The spinal cord when in a state of great irritation, whether this arise 
from inflammation, from violent irritation of nerves as in traumatic tetanus, 
or from the action of narcotic poisons, emits a constant motor excitement to 
all the voluntary muscles; (tetanus; epilepsy;) a similar state of irritation 
of the spinal cord, but slighter in degree, giving rise to intermitting move- 
ments, is observed in the diseases attended with chronic spasms, as chorea. 

148 Reviews. 

7. The force of our voluntary movements is also dependent on the motor 
tension of the spinal cord. 

8. The spinal cord is the source of the sexual power, the exercise of the 
sexual functions depends on it. 

9. " The influence exerted by this organ upon the organic chemical processes 
of the capillaries, through the medium of the organic nerves, is evidenced not 
only in the altered state of the cutaneous secretion in syncope, but still more 
clearly by ^the condition of the skin, in men in vi'hom the spinal cord has become 
affected in consequence of sexual excess. In these cases there is not merely 
general loss of power, but also diminished turgescence of the skin, diminished 
perspiration, dryness of the skin, and defective generation of heat, the feet, hands, 
and genitals are cold." 

10. "The spinal cord is also the subject of a morbid impression in all febrile 
affections, and the peculiar alteration of the sensations and motions and of the 
organic processes, the secretion and generation of heat, in fever can only be ac- 
counted for by the influence of such an organ as that which we have been con- 
sidering in this chapter." 

The third chapter is devoted to the physiology of the brain. We pass 
over the first division of the chapter which treats of the comparative anato- 
my of the brain of vertebrate animals; the author's observations under this 
head will not admit of analysis. In the second division are considered the 
powers of the brain, and the mental faculties generally. 

The brain undergoes, according to the author, a gradual increase of size 
from fishes up to man, in accordance with the developement of the intel- 
lectual faculties; this increase in size, however, is chiefly confined to the 
cerebral hemispheres. The cerebellum, also, becomes proportionably 
larger in animals higher in the scale, but in a far less marked degree. The 
corpora quadrigemina are actually smaller in proportion to the rest of the 
body, and the medulla oblongata, and its prolongations in the brain are not 
proportionably larger in man than in any other animal. 

Professor Miiller adduces the various arguments which prove that the 
brain is the seat of the mental faculties, that the mental functions are per- 
formed in no other parts of the nervous system, or of the body generally, 
but in the brain alone. The relation in which the other viscera stand to the 
mental emotions, the p-rofessor admits to be still involved in much obscu- 
rity. He is not acquainted, however, with a single fact which proves that 
in a healthy person a particular passion affects one organ more than another. 

"Although we are satisfied," he remarks, "upon grounds derived partly from 
comparative anatomy, and partly from physiology and pathology, that the seat 
to the mental operations is the brain and no other part; that the nerves excite 
these operations and are the instruments for executing what the mind directs, 
and that all the other parts of the body are subject to the influence of the nerves, 
still this amounts to nothing more than that the brain by its organization is the 
instrument by which the mind operates and is active: we do not assert that the 
'essence' of the mind has its seat in the brain alone. It is possible for the mind 
to act, and receive impressions, by means of one organ of a determinate structure, 
and yet be present generally throughout the body." 

The two following facts, according to the author, prove conclusively that 
the mind, although its only seat of action is the brain, is itself, nevertheless 
not confined to it. The first is that animals low in the scale propagate 
their species by spontaneous division, and as each portion of the divided 
animal evinces a separate will, and special desires, we have a distinct proof 
that the mental principle of these lower animals, whether it be or be not 
identical with their vital principle is also divisible. The second fact is 

Miiller's Elements of Physiology, 149 

that ill the higher animals and man, the female germ and male semen 
must^contain all that is necessary for the manifestation of the independent 
vital principle and the mental functions of the animal. In one or both of 
them the vital and mental principle must exist as it were in a latent slate, 
for otherwise these principles could not. manifest themselves, as they are 
observed to do, during the after developementof the new individual. The 
action of the mind is dependent, nevertheless, on the integrity of the 
fibrous structure and composition of the brain. The mode of mental 
action is always determined by the modification of structure and condi- 
tion of the organ; hence lesions of the brain invariably affect the operations 
of the brain, but the mental " essence," its latent power, as far as it does 
not manifest itself, appears to be independent of all changes in the brain. 

The author enters into an examination of tlie question, whether the 
vital and the mental principles are distinct, or whether the operation of the 
mind is merely a mode of action of the vital principle? But as he admits 
that it is not capable of solution by physiological facts, it is unnecessary to 
attempt an analysis of his remarks in relation to it. The same observation 
may be made in reference to another question discussed in the present 
chapter, whether, namely, mind be a property of matter, or an indepen- 
dent power, or principle. 

We can afford space for only a very general view of what Professor 
Miiller has advanced in reference to the functions of the medulla oblongata; 
his account of the course of the different columns or bundles of fibres of 
which it consists is particularly interesting but too long to permit us to 
extract it. 

The medulla oblongata has the general properties of the medulla spinalis; 
it has the property of reflection in a higher degree than any other part of 
the nervous system; it belongs to the motor apparatus, and no part has so 
great an influence on the production of motions; irritation of it excites con- 
vulsions of the whole trunk, and by lesions of it the whole trunk is para- 
lysed. The following properties, according to our author especially distin- 
guish it. 

1. It is the source of all respiratory movements; 2. It is the seat of vo- 
lition; 3. It is the seat of the faculty of sensation. This, he conceives, is not 
merely shown by the anatomical fact that all the cerebral nerves, with the 
exception of the first and second, are connected with it, or with its prolon- 
gations in the brain, but is proved also by the history of experiments on 
different parts of ihe encephalon. It is not true, however, that the medulla 
oblongata is the central organ for all sensations; in a restricted sense, it is 
certainly the receptacle for all the sensations of touch; but, it would appear 
that the central organs of the different senses are independent of each other; 
if they do in part belong to the prolongations of the fasciculi of the medulla 
oblongata, still it appears that their actions may be isolated, a reciprocal 
action of each with the hemispheres of the brain being necessary for a 
distinct perception of the sensation of which it is the seat. This is proba- 
ble. Professor Miiller remarks, but many facts are wanting to prove it. 

The corpora quadrigemina of mammalia, and the lobi optici of birds, 
reptiles, amphibia, and fishes, belong, with the optic thalami of the higher 
animals, to the central apparatus of the sense of vision. 

The functions of the cerebellum have been made the subject of interest- 
ing experiments, by Rolando, Flourens, Magendie, Schoeps. and Hertwig. 


150 Reviews. 

M. Rolando constantly observed that the diminution of the movements 
was in a direct ratio with the lesions of the cerebellum; that stupor 
was never produced nor the sensibility of any part of the body impaired; 
but that the power of muscular movements was lost. M. Flourens, whose 
experiments are clearer and more decisive in their results, infers that the 
cerebellum belongs neither to the sensitive nor to the intellectual apparatus; 
and that it is not the source of the voluntary movements, although it be- 
longs to the motor apparatus: the infliction of wounds in it does not, how- 
ever, he says, excite convulsions; but the removal of it destroys the force 
of the movements, and the faculty of combining them for the purposes of 

" If this view be correct, Professor Miiller observes, the cerebellum must con- 
tain a certain mechanism adapted to the excitement of the combined action of 
muscles, so that every disturbance of its structure must destroy the harmony 
between this central organ of combined motions, and the groups of muscles with 
their nerves. It is also to be remarked, that injury to the cerebellum always 
produces its effects on the opposite side of the body." 

The observations of Flourens are confirmed by Hertwig. M. Magendie 
found that wounds of the different portions of the cerebellum caused 
various disorders in the voluntary movements; these experiments are too 
well known to require that they should be more particularly noticed here. 
The results were, to a certain extent, the same in Hertwig's experiments. 

In regard to Gall's doctrine that the cerebellum is the organ of the 
sexual impulse, Professor Miiller regards the grounds upon which it is 
founded as not conclusive, while several facts are met with in opposition 
to its correctness. 

All the facts derived from comparative anatomy, and from direct ex- 
periment, prove that the cerebral hemispheres are the seat of the higher 
intellectual faculties — that in them the sensorial impressions are not merely 
perceived, but are converted into ideas, and that in them resides the power 
of directing the mind to particular sensorial impressions — the faculty of 

"In what respect," the author remarks, "the medullary and the gray sub- 
stance of the hemispheres differ with regard to function, we are quite ignorant. 
The capacity of the mind in different animals manifestly increases, jaaK joassw, 
with the extension of the surface of the cerebral convolutions; but we have not 
the slightest knovrledge of the nature of the influence exerted by the gray cor- 
tical substance into which the innumerable fibres which pass through the optic 
thalami at last radiate. We are ignorant of the nature of the change produced 
in the medullary fibres, in the cortical substance or in the principle which ani- 
mates it, when an idea makes an impression on the highly susceptible substance 
of this wonderful structure." 

" It is probable that there is in the brain a certain part or element set apart 
for the affections, the excitement of which causes every idea to acquire the in- 
tensity of emotion, and which, when very active, gives the simplest thought, 
even in dreams, the character of passion; but the existence of such a part or 
element cannot be strictly proved, nor its locality demonstrated. Still less can 
it be shown that, independent of such an element of the mind, the particular 
tendencies of the thoughts and passions have their special seat in distinct dis- 
tricts of the hemispheres." 

This view, which forms the ground work of the doctrine of phrenology, 
Professor Miiller entirely rejects, not because it involves an impossibility, 
but because there are, in his opinion, no facts calculated in the slightest 

M\i\\ex's Elements of Physiology, 151 

degree to prove the correctness of the hypothesis generally, or the correct- 
iiess;^of the details founded upon it. But we cannot follow him in his 
further remarks on this subject. 

With regard to their action in the intellectual functions, one hemisphere 
of the cerebrum, the author remarks, appears to be capable of performing 
the office of both. Cases have been observed, at least, in which permanent 
diseases, or even complete atrophy of one hemisphere has left the mind 
unimpaired. The commissures appear to be the cause of this union of 
action of the hemispheres. The iniluence of the corpus callosum is not 
quite certain; neither its presence nor that of the fornix would appear, 
from a case recorded by Riel, to be necessary for the exercise of the lower 
mental faculties. Tumours and hydatids have been found attached to the 
corpus callosum in idiots, and La Peyronnie observed loss of memory at- 
tending lesion of tliat part of the brain. 

The functions of the pituitary and the pineal gland are, we may say, 
entirely unknown. 

The present chapter concludes with some very interesting remarks on 
the laws of action of the brain and spinal cord; of these we are able to 
notice but a few of the more important. 

The experiments of Flourens and Hertwig show that of the motor 
apparatus some when wounded excite convulsions, while of others the 
mutilation diminishes the motor power without causing muscular spasms 
to ensue. The first class includes only the corpora quadrigemina, the 
medulla oblongata, and the spinal cord; to the latter cl'ass belong all the 
motor apparatus of the encephalon, namely, the optic thalami, the corpora 
striata, the pons Varolii, and the cerebellum. 

"From experiments on animals, and pathological observations, it results that 
lesions of the spinal cord and medulla oblongata always cause convulsions or 
paralysis on the same side of the body. This is qinte intelligible in the ease 
of the spinal cord, for in it there is no decussation of the fibres of the two lateral 
halves; but, with reference to the medulla oblongata, the above result of the 
experiments of Flourens and Hertwig is not perfectly consonant with the ana- 
tomical structure of the part — for since, in the medulla oblongata, the fibres of 
corpora pyramidalia at least decussate, while those of tlie other fasciculi con- 
tinue their course on the same side of the spinal cord, it would be expected that, 
according to the part of the medulla oblongata affected by the lesion, the con- 
sequences would be observed on the opposite or on the same side of the body. 
M. Lorrey had indeed observed, that when wounds were inflicted upon the me- 
dulla oblongata, the convulsions were constantly on the same, the paralysis on 
the opposite, side of the body. To this result, however, those of the experiments 
of Flourens and Hertwig are directly opposed; but we must recollect that their 
experiments were instituted principally on the lateral columns only, which do not 
decussate; and it is very probable that, if the corpora pyramidalia be wounded 
above the decussation of the fibres, the effects produced would be seen on the 
opposite side of the body." 

Injuries inflicted on the cerebellum, the corpora quadrigemina, and 
cerebrum are always productive of loss of power on the opposite side. 

Flourens, Professor Miiller remarks, appears to have gone too far in 
concluding that lesions on one side the cerebrum cannot give rise to con- 
vulsions on the same side of tlie body: in the cases of lesion of one side of 
the brain, collected by Burdach, convulsions occurred in twenty-five cases 
on the same side as the disease, in three only on the opposite side. In 
cases of lesion of one corpus striata, there were, with thirty-six instances 

152 Reviews. 

of paralysis of the opposite side of the body, convulsions of the same side 
as the disease in six instances, and in no instance convulsions of the 
opposite side. 

" When the decussation of the corpora pyramidalia of the medulla oblongata 
became known, the explanation of the cross actions of the brain by this struc- 
ture was too obvious not to be immediately adopted; and the concurrence of the 
cross influence of the brain with this structure of the corpora pyramidalia, 
proves that these are the parts in the medulla oblong-ata which are principally 
engaged in conducting the motor influence from the brain to the trunk. 
There is great difficulty in explaining the modes of action of the brain in its 
influence on the cerebral nerves of the opposite or same side of the body. For 
since these nerves arise, for the most part, above the point of decussation of the 
pyramidal bodies, the cause of the cross action of injuries of the brain on these 
nerves must have some other seat; and what involves the question in still more 
difficulty, is, that in man, the nerve of the same side is as frequently aflTected 
as that of the opposite in cases of cerebral lesion." 

From the facts he has laid down relative to the laws of action of the 
brain and of the spinal cord, Professor Miiller proposes a classification of 
the different kinds of paralyses and convulsions, with a reference to the 
seat of the cause which produces them. 

I. Paralyses. — Paralysis may have its seat in individual nerves, or it 
may be the result of disease of the brain and spinal cord. The first or 
local paralysis arises from any cause which destroys in the nerves their 
power of propagating nervous action, as rheumatic affections, division, 
tumours, &;c. When the cause of the paralysis is seated in the central 
organs, the loss of power aflfects either a vertical half of the body, hemi- 
plegia, or a horizontal half, paraplegia. In the first form, the cause has 
its seat on one side of the brain and spinal cord; in the second, it is gene- 
rally seated on both sides, but may be on one side only. 

a. Paralysis from Diseases of the Spinal Cord. — Here the disease is 
generally indicated by the extent of the parts paralysed. Injury of the 
lumbar portion of the cord constantly paralyses the lower and never the 
upper extremities. If tiie arms be paralysed, the lesion must have its seat 
above the origin of the brachial nerves — but the lower limbs are in this 
case not necessarily affected. Lesion of the medulla oblongata paralyses 
the cerebral nerves which arise from it, as well as the whole trunk. The 
eff'ects of disease of the spinal cord are always seated on the same side as the 
lesion. When the sensibility only of the limbs is lost, the cause, most pro- 
bably, but not constantly, has its seat in the posterior columns of the cord; 
if it be motion which is lost, the anterior columns are more frequently, 
but not invariably, the seat of the lesion. Paralysis from disease of the 
spinal cord is sometimes complete; the propagation of cerebral influence 
being wholly interrupted at some point; at others incomplete, the influence 
of the will being still transmitted to the muscles, but the intensity of the 
motor power is lost — this is what is observed in atrophy of the spinal cord 
or tabes dorsalis. 

h. Paralysis from Disease of the Encephalon. — The paralytic affections 
of this class may present themselves in any part of the trunk, in the face 
as well as in the upper and lower extremities. Hence, paralysis of the 
leg, and'of the sphincters, may be the result of disease of the brain or of the 
•pinal marrow. We may infer it to depend on the first when other parts 
or functions are affected which are under the inffuence of cerebral nerves, 
as the muscles of the eye, vision, hearing, speech, &c. The paralysis 

Mailer's Elements of Physiology. 153' 

may consist of either loss of motion or of sensibility, or of both. The 
first form may depend on lesion of the corpora striata, the optic thalami, 
the investments of the cerebral hemispheres themselves, the corpora quad- 
rigemina, the pons, the medulla oblongata, or the cerebellum. Serres, 
Bouillaud, and Pinel Grand-Champ maintain that they have found paralysis 
of the upper extremities more frequent from disease of the optic tbalami; 
paralysis of the lower extremities from disease of the corpora striata; this 
is not, however, an established fact. When it is sensibility that is im- 
paired, the seat of the disease varies. Blindness most frequently results 
from degeneration of the cerebral hemispheres, particularly of the optic 
thalami, or from disease of the corpora quadrigemina. Loss of common 
sensation is most frequent in disease of the medulla oblongata. Paralysis 
from encephalic lesions may be complete or incomplete; the loss of motor 
power is most prone to be complete when the lesion is seated in the cor- 
pora striata, optic thalami, crura cerebri, or pons. Incomplete paralysis 
is most generally dependent on disease of the cerebral hemispheres, or of 
the cerebellum. 'I'he paralysis is most apt to be attended with convulsions 
or spasmodic contractions of muscles, when the corpora quadrigemina, the 
medulla oblongata, or the parts at the base of the cerebrum, are the seat of 
the disease. Paralysis of the trunk is generally on the opposite side to 
the disease — paralytic affections of the head as frequently on the same as 
on the opposite side. 

II. Convidsions. — Their cause may be seated in the nerves, in the 
spinal cord, or in the brain. 

a. From Disease of the Nerves. — Such are the convulsions caused by 
reflection on motor nerves, by the spinal' cord or brain, of an influence 
communicated to them, either from local diseases of nerves, as tumours or 
neuralgic affections — from any strong impression on sensitive nerves; or, 
in children, from any local disease. 

b. From Disease of the Spinal Cord. — These are regulated by the same 
laws as paralytic affections from disease of the same part. 

c. From Disease of the Brain. — These also observe the same laws as 
paralysis from cerebral disease. Lesions, however, of the cerebral hemis- 
pheres, the cerebellum, and the pons, are more prone to cause paralysis- 
lesions of the corpora quadrigemina and medulla oblongata, to cause both 
paralysis and convulsions. 

Being desirous to present lo our readers a tolerably full outline of that 
portion of Professor Miiller's work which treats of the physiology of the 
nervous system, embracing, as it does, one of the most complete exposi- 
tions of the present state of our knowledge in relation to that most im- 
portant subject, we have left ourselves no space for a notice of the suc- 
ceeding division of the work — which treats of motion, voice and speech. 
Even had we seen proper to condense our analysis of the preceding 
division within a much smaller compass, we should have been equally 
obliged to pass over the author's very able summary of the facts in relation 
to the last mentioned subjects. To present a satisfactory analysis of this 
portion of the elements would be scarcely possible; we shall content our- 
selves, therefore, with a very brief notice of one or two particulars con- 
nected with the physiology of motion. 

"The vital motions of the solid parts of animals," remarks Professor Mviller, 
" present two principal kinds, differing in the organs of their production, in their 
phenomena and their causes: they are, the motion from contraction of fibreSj 

154 Reviews. 

and the oscillatory motion of cilia with free extremities, in which no other 
organic apparatus of motion can be distinctly demonstrated. The first kind oi 
motion is produced by the shortening- of fibres, which either have a longitudinal 
direction, and are fixed at both extremities, or form circular bands; the contrac- 
tion or shortening- of the fibres bringing- the fixed parts nearer to each other. 
This kind of motion is generally effected by means of muscular fibres; in some 
few instances it is produced by,fibres which differ from the muscular in structure 
and chemical properties. The second kind of motion consists in the vibration, 
in a determinate direction, o^ microscopic cilia with which the surfaces of certain 
membranes are beset. Here only the base of the motor organ is attached. By 
the motion of the contractile fibres, and especially by muscular motion, solid 
parts of the body are approximated to each other, or fluids are impelled onwards 
in muscular tubes. By the motion of cilia, fluids and minute microscopic par- 
ticles of solid matter are merely made to move over the surface of membranes; 
the fluids do not here fill the entire cavity of the tubes, nor do the membranes 
themselves contract. The motion due to contractile fibres prevails much more 
extensively through the body than the ciliary motion.'-' 

The motion of vibrating cilia is observed on certain membranes both in 
the animal and organic portion of the body; it is probable that it exists, at 
least in some of the lower animals, in the interior of the vessels. It is 
seen in many of the lower animals over the entire surface. In the higher 
animals, it is seen on the surface of the body during the embryo state only. 
It has been observed by Purkinje, to exist in the parietes of the ventricles 
of the brain, both in the embryonic and adult state of mammalia. In the 
higher animals, the mucous membranes (not all of them) present it even 
up to man himself. 

" It is possible," the author remarks, "that the motion of nutritive fluids 
which is observed in the lower animals where there is no heart and no distinctly 
contracting vessels, is, in all cases, merely the effect of the motion of cilia; and 
the circular motion of the sap in the cells of many plants may be produced in a 
similar way." 

The ciliary motion does not exist, in mammalia and birds, either in the 
cavity of the mouth or in the pharynx and oesophagus. It has been found 
in the mucous membrane of the larynx, trachea, and bronchi, by Puskinje 
and Valentin, in all the air breathing vertebrata. In the nasal cavity, the 
frontal and maxillary sinuses and in the Eustachean tube it is invariably 
present. In vertebrate animals, it has been found by Purkinje and Va- 
lentin to occupy the mucous surf^ices of the female organs only — it is 
entirely wanting in llie urinary organs of the vertebrata. It has been dis- 
covered on the lining membrane of the ventricles of the brain by Purkinje 
and Valentin in man, many mammalia, birds, amphibia and fishes. It 
extends through all the ventricles of the brain, and all the cavities of the 
brain and spinal cord in the fcetus and embryo. In relation to ciliary 

"In the present state of our knowledge, thus much may be advanced: 

" 1. That the ciliary motion of the mucous membranes is due to the action 
of some unknown contractile tissue. 

"2. Which lies either in the substance of the cilia or at their base. 

" .3. That this tissue resembles in its contractility the muscular and other 
contractile tissues of animals. 

"4. That its properties in so far agree with those of the muscular tissue, at 
all events with that of the involuntary muscles of the heart, and with the 
vibrating laminas of the lower Crustacea, that the motions which it produces 
eontinue without ceasing with an equable rhythm. 

Ellis 071 Insanity. 155 

"5. That its properties agree also with those of the muscular tissue of the 
heart, in its motions continuing long after the separation of the part from the 
rest of the animal body. 

" 6. That this tissue differs essentially, however, from muscle, in the circum- 
stance of its motions not being arrested by the local application of narcotics. 

" 7. That the ciliary motion presents itself under conditions where it is not 
probable that a complicated organisation exists, namely, in the undeveloped 
embryos of polypiferous animals." 

The muscles of animal life, according to Professor Miiller, are distin- 
guished from those of the organic portion of the body, not merely by their 
moving under the influence of volition, by their deeper red colour and 
greater solidity, but also by the great difference in their microscopic cha- 
racter. The primitive muscular fasciculi of the animal sysletn present, 
under the microscope, transverse markings, while the primitive fibres of 
these muscles have regular enlargements following each other in close 
succession; the fasciculi of the muscular coals of the intestines, urinary 
bladder and uterus are destitute of these cross markings, and their primi- 
tive fibrils are uniform, not varicose threads. 

Professor Miiller describes three modes in which muscles can become 
shorter during their contraction: 1. By the zigzag inflexion of the muscular 
fasciculi. 2. By the contraction of the primitive fibres, which contraction 
Laulh supposes to be effected by the approximation of globules composing 
the fibres; and 3. By the approxiniation of the bead-like enlargements, 
and contraction of the interspaces between these enlargements of the primi- 
tive fibres. 

"Such a mode of contraction," he observes, speaking of the latter, "can 
neither be demonstrated, nor proved not to take place. The absence of the 
beaded enlargements in an entire class of muscles would render any theory of 
muscular contraction defective which was based on them. Still, the approxima- 
tion of the globules of the primitive fibre may very possibly take place in the 
muscles of animal life, in addition to the other modes of contraction which are 
seen in the primitive and secondary fasciculi; and that there are in fact some 
reasons for believing that in them it actually does occur." 

But we must here close. To such as desire to make themselves ac- 
quainted with all that is at present known concerning the physiology of 
motion, of voice, and of speech, we recommend a careful study of the seve- 
ral sections of the work before us devoted to these subjects. D. F. C. 

Art. XV. ^^ Treatise on the Nature, Symptoms, Causes and Treatment 
of Insanity^ with Practical Observations on Lunatic Asylums, and a 
Description of the Pauper Lunatic Asylum for the County of Mid- 
dlesex, (Eng.) at Hanwell; with a Detailed Account of its Manage- 
ment. By Sir W. C. Ellis, M. D., Resident Medical Superintendant, 
and formerly of the Asylum, Wakefield. London: 1888. 8vo. pp. 344. 

Since the appearance of the valuable work of Dr. Prichard upon the 
Diseases of the Mind, the volume of which the title forms the caption to 
this article, is the most important that has been published in the English 

156 Reviews. 

language. The author is a gentleman of long experience in the manage- 
ment of the insane. Sir William Ellis, as he informs us in the preface of 
his book, has resided in tlie Asylums of Wakefield and Hanwell nearly 
twenty years. During this period, more than 2700 cases of insanity have 
come under his "immediate care and observation." The volume con- 
tains 344 pages, and is divided into ten chapters, the subjects of which 
are as follows, viz: — Chap. 1. Introduction; in which his theory of the 
disease is set forth; — 2. The nature of insanity; — 3. Causes; — 4. Symp- 
toms; — 5. Idiocy and fatuity;-— 6. Treatment; — 7. Apoplexy, epilepsy, 
and the diseases of the insane; — 8. On the construction of Asylums, and 
their mode of management; — 9. On the distinction between conduct which 
is the result of moral evil and that which arises from insanity; — 10. Con- 

It is not a compend of statistics, its object being " to point out the symp- 
toms by which an attack of the disease (insanity) may be foreseen, and the 
means by wliich it may be warded off: and, in those cases where it has 
already supervened, to explain the mode of treatment most likely to restore 
the patient to reason and society; and, where this is impossible, to show 
liow the suffering may be alleviated, and life rendered, if not a stale of 
happiness, at least one of moderate enjoyment." 

In the second chapter the author enters into an argument, somewhat 
prolix, to demonstrate, 1st, That "man is sane when the manifestations of 
his mind, his sentiments, passions and general conduct continue either to 
improve or to keep in accordance with the exhibitions of his previous 
powers and habits:" — 2d, That "there is a necessary connection between 
the mental manifestations and the state of the brain; and that, at all events, 
in extreme cases of complete torpor and excited action, the injurious alter- 
ation that results in the intellectual manifestations and the conduct, is to be 
traced to the state of the brain:" — And, 3d, that, " as we know that the 
assistance of the brain is necessary to our intellectual manifestations, to our 
sentiments, and to our passions," we may " reasonably infer that the inju- 
rious alteration which is the invariable attendant upon insanity, may, in 
like manner, in less extreme cases, be traced to the brain." 

With all due deference to the author, both as a skilful physician and a 
learned man, we must avow that we were not a little surprised at finding 
him advance a claim of originality to a theory of this kind. An attempt to 
prove the first of the three propositions, which, in the work, are arrived 
at as " conclusions," or inferences, we consider to be an absurdity almost 
as glaring as an endeavor to substantiate, by mathematical demonstration, 
the axioms of Euclid. To what standard of the normal action of the mind 
of any individual can we refer, if it be not to its previous action? Certainly 
to none, excepting in " cases of idiocy, imbecility, eccentricity and moral 
evil," which the author himself excludes from his pseudo-original "con- 

With regard to the second proposition, our surprise that it should be 
claimed as original arose from the fact that the principle therein involved 
is identical with that which we have long maintained in reference to insan- 
ity, and what we believed to have been the sentiment of Spurzheim, Combe 
and a host of other writers on phrenology and physiology. We believe 
it to be a principle almost inevitably arrived at by the attentive student of 
human physiology. It is evident, from various parts of his work, that the 
author is a thorough-going phrenologist, believing in the details of that 

Ellis on Insanity. 157 

science to an extent to which we cannot follow him, and carrying its prin- 
ciples into practice to a degree beyond what, it appears to us at least, 
facts will sanction. Speaking of the opinions respecting insanity which 
have prevailed in different ages, he acknowledges that '' within a last few 
years the doctrine of its being a bodily disease seems again to prevail." 
It appears to us that this is equivalent to an admission of a want of origi- 
nality in the theory under notice; for, among intelligent men, who, that 
believes in the " doctrine of its being a bodily disease," would presume to 
attribute it to any portion of the body, othf r than the brain? 

In justice to the author we make the following extract from his work, 
showing that the first proposition, or "conclusion," was not wholly un- 
called-for, whether it did or did not originate, primarily, in the mind by 
which it is now promulgated. 

"The history of the last few years will, unfortunately, bring to our recollec- 
tion too many fatal incidents which have arisen from individuals of the most 
exalted rank not having been properly confined, solely because, in their insanity, 
they have exhibited intellectual powers greater than those which are usually 
found among mankind; although, if their previous habits and capacities had 
been attended to, such an alteration would have been seen as would have proved 
the necessity for confinement." 

But, to come to the theory: the author adduces, in its support, the re- 
sults of autopsic observation. He says that " in old cases, diseased or- 
ganization of the brain is almost invariably found;" and again, in recent 
cases, " though organic lesion is rarely perceived, yet the vessels on the 
whole surface of the brain are surcharged with blood, and clearly indicate 
the existence of increased cerebral action." Of 154 male patients ex- 
amined after death, " 145 had disease, very strongly marked, either in the 
brain or the membranes. Of the nine remaining, two were idiots from 
birth; one died of dysentery, another of epilepsy; the other five cases had 
not been insane more than a few months, and died of other diseases. Of 
the females, 67 were examined, and 62 found with disease in the brain or 
membranes; in the other five no disease was to be discovered. Two of 
these were idiots from birth, and, with one exception, the others recent 

No other observer has found organic lesions of the encephalon or its 
meninges in so great a proponion of cases as has Sir William Ellis. — 
"Whether tijis has arisen from a more accurate observation of patholo- 
gical phenomena, or from that tendency, so universally existent, to 
magnify appearances wlienever a favourite theory is to be supported, we 
are unable to determine; but we are induced to believe, that it is from the 

The concludinof part of the second chapter is devoted to a discussion and 
attempted refutation of some objections to the theory that insanity is a 
purely menial disease, and "a consideration of the extent of the alteration 
which tnusi exist before it becomes requisite lo treat the patient as insane." 
In respect to the latter snbjert, the conclusion is deduced, that when there 
is a lesion of the powers of perception, and the reason is not aifected, or 
if th(! latter be aflected so that it cannot correct the false impressions, and 
those impressions are not of such a nature as to interfere vviiii the ordinary 
occupaiions of the patient, or render him obnoxious to society, he ought 
not lo he taken from his family and friends. This principle is illustrated 
by cases. In the same way, where the judgment or the power of reason 

No. J.I.— May, 1840. 14 

158 Reviews, 

is so far affected as to prevent the individual from arriving at accurate con- 
clusions, confinement or restraint ouglit not to be resorted to, so long as 
those conclusions are unproductive of harm, either to the patient or to 
others. In pursuing the question, the author adverts to the temporary in- 
sanity produced by intoxication, which arises from a voluntary act, and 
concludes with the following distinction. *' If the paroxysms (of insanity), 
however violent, result from causes within the immediate control of the 
individual, he ought to be amenable to the laws for his actions; if, on the 
contrary, they have their origin from sources entirely or remotely out of 
his reach, justice, as well as humanity would attribute the act to madness, 
and forbid his punishment." 

On the Hereditary Predisposition to Insanity. — At the present day, the 
arguments from analogy introduced by the author, are hardly required to 
demonstrate that, by a similarity of organization or of molecular arrange- 
ment, between parent and child, the latter may, and but too frequently 
does, inherit a predisposition to mental disease. Of 1.380 patients under 
the care of Sir W. Ellis, it was found that the parents or relations of 214 
had previously been insane. In 125 of them, no cause of the disease, 
other than hereditary taint, could be ascertained. The others were pro- 
duced by moral and physical causes. Great importance is attached to a 
proper education as a means of preservation from insanity. Habits of self- 
government should be taught in early life, that the individual may be able 
to support unharmed, the various trials which may be met with in after 
life. Infant schools are deprecated, on the ground that they exercise the 
brain to too great an extent, before it has acquired a consistence suitable 
for labor. A diminution of the force of the mental powers and a tendency 
to encephalic disease, are believed to be the necessary results. The he- 
reditary predisposition is so strong, in some persons, that no method of 
education can preserve them from the disease. Particular forms of insanity 
especially that accompanied by a suicidal propensity, are often inherited. 
A woman, S. T. became insane, tier mother and two of her sisters had 
hung themselves. She was prone to commit suicide and after having 
been deranged more than two years, effected it, by hanging. 'I'he children 
of relatives by blood, who have intermarried, are predisposed to insanity. 
This is asserted to be true, from the observation of both the author and 

Causes of Insanity. — On the supposition of the truth of the theory of 
insanity set forth by the author the causes of the disease are reduced to two 
classes: 1. those which act primarily on the brain and nervous system, 
and 2. those which cause disease in these organs merely by sympathy.—- 
In the first class are arranged, 1. Blows on the head; 2. Insolation, or 
coup de soleil: 3. Old age: and 4. Over exertion. Cases are reported 
illustrative of each of these causes. In reference to some cases of insanity 
attended with stupefaction, caused by blows on the head, which cases 
have been instantaneo sly cured, it is asked, " As in apoplexy, a very 
small quantity of blood, suddenly effused, is sufficient to produce death, 
may noisome part of the brain be internally pressed upon in these cases, 
by the sudden accumulation of a very little access of fluid, yet still sufli- 
cient to cause the stupefaction? Is it unreasonable to suppose that this 
pressure may be taken off by some internal operation, as instantly as that 
of the bone by the trephine?" In illustration of this peculiar variety of 
insanity, the case is reported of a man, 30 years of age, who was insane 

FiWis on Insanity. 159 

three months, no cause for the disease being known. One morning he 
was found to be restored to mental health, but could remember nothing 
which occurred during the period of his alienation. Senile insanity, or 
that of old age, is very properly attributed to a brain, " weakened and 
worn out." Tlie mind itself remains unchanged, the intellectual faculties 
and the moral affections retain their integrity and their brightness, but the 
organ through whiim they are manifested, injured like every other portion 
of the body, by continued exertion, no longer preserves the power of such 
perfect action as it exhibited in earlier years. In every case of senile in- 
sanity which was examined after death, lesions of the brain or its meninges 
were discovered. The pathological appearances of five of them are report- 
ed. In one, the dura mater adhered to the cranium; in two the pia mater 
was thickened; in one the arteries minutely injected; in three the arachnoid 
was opaque, being thickened also in two of them; in one there was serum 
between the membranes, and in another, beneath the arachnoid. In three 
the substance of the brain was soft; in one it was flaccid, shrunk and ex- 
sanguineous. The quantity of serum in the ventricles varied from two to 
eight ounces. In one case the plexus-choroides had hydatids on both its 
sides, the septum lucidum was open and the cerebellum flaccid. 

It is asserted that over exertion is " by far the most general primary 
cause of diseased action of the brain and, therefore, of insanity." The 
modus operandi of this cause is described, and cases illustrative of it are 
adduced. The cases produced by intellectual effort, are not alone referred 
to this head, but also a very large proportion of those which arise from 
moral causes. Among the patients in the asylums at Wakefield and Han- 
well which are institutions for the poor, distressed pecuniary circumstan- 
ces is the predominating moral cause of the disease. The most frequent 
instances of insanity, thus produced are among the honest and industrious. 
Poverty is not only the frequent original cause, but it occasionally induces 
a relapse of the malady. Interesting cases are related, in which timely 
pecuniary aid probably prevented results of this kind. 

Grief and intense thought upon religious subjects hold the next rank, in 
reference to the number of cases which they produce. We have remarked 
in a former paper, that in the statistics by Esquirol, of the asylum, at 
Charenlon, not an individual case is referred to religious thought as its 
cause. The paucity of cases having this origin, upon the continent, is 
adverted to by Sir W. Ellis, and satisfactorily accounted for by the preva- 
lence of "infidelity among the higher orders" and "ignorance and blind 
superstitious obedience to the dictum of the priests, amongst the lower 
classes," together with the fact that religious discussion is prohibited in 
some of the continental countries. In the experience of the author by far 
the largest portion of patients whose insanity was produced by grief were 
females. A. majority of these became deranged from the loss of children. 
Joy and fear are next referred to as moral causes. An interesting case 
attributed to the former is quoted from Dr. John Mason Good. One pro- 
duced by the latter, and which came under the observation of the author, 
is reported. In connection with this subject another case is related which, 
from lis painful interest, as well as from its value as a warning, we proceed 
to extract. "A melancholy instance of the effect of terror happened, a 
few years ago, in the north of England. A lady had gone out to pay an 
evening visit, at which she was expected to stay late. The servants took 
advantage of the absence of the family to have a party at the house. The 

160 Reviews, 

nurse maid, in order to have enjoyment without being disturbed by a little 
girl who was entrusted to her care, and who would not remain in bed by 
herself, determined to frighten her inio being quiet. For this purpose she 
dressed up a figure and placed it at the foot of the bed and told the child 
if she moved or cried it would get her. In the course of the evenino- the 
mother's mind became so forcibly impressed that something was wrong at 
home, that she could not remain without going to ascertain if any thing 
extraordinary had occurred. She found all the servants dancing and in 
great glee; and on inquiring for the child, was told that she was in bed. 
She ran up stairs and found the figure at the foot of the bed, where it was 
placed by the servant, and her child with iis eyes intendy fixed upon it, 
but, to her inexpressible horror, quite dead." 

Mortified pride, disappointed love, and jealousy are the last of the moral 
causes enumerated. These, like the others, are illustrated by cases which 
have occurred >vithin the observation of the author. 

At the head of the causes in the second class, or those which act upon 
the brain by sympathy, are placed the disorders of the chylopoietic viscera. 
In these cases, a train of hypochondriacal symptoms exists before ihe 
patient is absolutely insane. 

It is frequendy difficult to determine which was the original disease, 
that of the brain or thai of the chylopoietic viscera. Many cases of in- 
sanity have originated, apparently, from sympathy with diseased lungs. 
In many instances, however, as in the case just mentioned, it is extremely 
difficult to ascertain which of the two was the original lesion. This 
form of mental disease appears to be connected with hereditary predis- 

Exposure to cold is frequently tlie determining causes of insanity in 
those who are predisposed to encephalic disease. To this cause, con- 
nected with poverty and an indifl^erent diet, much of the insanity of agri- 
cultural labourers owes its origin. Repelled eruptions and the suppres- 
sion of secretions and of evacuations, both natural and accidental, are the 
causes next illustrated. Gestation and parturition follow. Two cases, 
produced by the former, are reported. " After delivery," the author re- 
marks, "insanity more frequendy arises from the brain sympathising 
with the uterus, from the stopping of the lochia, or from its sympathising 
with the breasts, from cold or any other cause interrupting the secretion of 
the milk." 

In persons once afflicted with puerperal insanity, relapses are frequent 
during subsequent pregnancy. This may be prevented by proper treat- 
ment. Fevers, whether sthenic or asthenic, are productive of insanity, 
the former by too great determination of blood to the brain, the latter 
from weakness of ihat organ. The following distinction between insanity 
and the mere delirium sometimes attendant upon fevers, is not without a 
practical bearing. "In delirium from fever there is a total derangement 
of all the intellectual faculties. The powers of perception suflTer, no less 
than the reasoning and affi^ctive; the language of the patient is confused, 
and, generally, an unintelligible mass of ords without any definite mean- 
ing. Now, in insanity, it never happens that all the intellectual faculties 
are at the same time disordered, except when the patient becomes delirious 
from fever, to which he is, of course, as liable as those who are sane. The 
insane possess a knowledge of the objects around them, and a power of 
reasoning, although incorrectly: whilst, in delirium, volition and even con- 


Ellis on Insanity. V61. 

sciousness seem to be suspended. We may also be certain that when the 
disordered action of the brain has continued some time after the fever 
which caused it has censed, and the pulse is natural, whatever else may- 
be the symptoms, the patient is insane and not delirious." 

Afier asserting that all kinds of vice have a tendency to debilitaie the 
whole system, and hence, as the brain is affected in common with the 
other organs to produce insanity, the author thus proceeds: " But there 
is a vice, the secret and unsuspected iiululgence of which seems, in addition 
to its weakening the general powers, to have a specific and direct tendency, 
in many constitutions at least, to operate U[)on the brain and nervous sys- 
tem." And, in a note ap[)ended to the wtirk, he farther observes. ''Mas- 
turbation, the cause alluded to, is a fertile source of insanity. 1 have no 
hesitation in saying that in a very large number of patients in all put)lic 
asylums, the disease may be aitribuied to that cause. The general debdiiy 
which is produced by this disgusting habit, is more severely felt in the 
brain and nervous system in some constitutions than in others, and whilst 
a pale face, general lassitude, drowsiness, cold extremities, irembliuii hands, 
and a voracious appetite, are the indications of its existence in one, the 
brain is the first part to give way in another, ami insanity takes place. 
We must not, however, omit to mention that the practice is often the con- 
sequence as well as the cause of ihe disease." 

We observe that in the last report of Dr. Woodward, Superintendant of 
the Massachusetts State Lunatic Hospital, the practice above alluded to is 
stited to have been the cause of 81 of the 855 (;ases which had been re- 
ceived into that institution up to the close of the year 1838. If such be 
the case, and a corresponding proportion of the patients in other institu- 
tions of a similar character, have brought the fearful makdy of insanity 
upon themselves by an indulgence in the same pernicious habit, it is a 
subject tliat certainly merits the attention of every writer upon the disease, 
as well as that of all who are either directly or indirectly interested. We 
know of no other treatise upon insanity which contains so great an amount 
of useful* information in regard to this specific subject, as that which we 
have under consideration. An Appendix of several pages is exclusively 
devoted to it. From this we make some extracts: " Unhappily it (the 
practice in question) has not hitherto been exhibited in the awful light in 
which it deserves to be shown. A great deal has been said on dementia 
by previous writers on insanity, but this, the true cause of its origin, in 
by far the greater number of cases, has not been mentioned. It is often 
begun in very early youth. I have had under my care a child almost in 
a stale of fatuity from this cause, at ten years of age, but who subsequently 
recovered; and I have recently been informed, on authority the accuracy 
of which I cannot doubt, of similar effects being produced by the same 
causes, in a child not more than eight years old. In the present artificial 
state of society, where marriages are too frequently prevented only from 
the want of what are considered sufficient pecuniary means, and where 
scenes of dissipation are prevalent, and a highly siimulaiing and exciting 
mode of living is adopted, this vice, as it might be expected, is unfortu- 
nately continued in after-life." ***** 

" When in Paris, I accidentally met a French Surgeon, Mons. A. Gerentel, 
who then resided in the Palais Royal No. 36; he informed me that he had dis- 
covered an effectual mechanical preventive. *****! have recently been 


162 Reviews, 

informed that he has been in London, and that his contrivance is valuable; when 
I saw him he had not one made, and I understood from him that, in order to be 
of any use, they must be fitted for the particular person intended to wear them. 
If the patient is alive to the deplorable consequences already caused by the 
practice, and to those still worse which are to follow from its continuance, so 
as to be induced to abstain from it, he may g'enerally be restored. To assist 
his good resolution he ought, on going to bed every night, to have his hands 
secured. He should sleep upon a hard mattress, without curtains, and the room 
should be particularly dry. Cold ablutions about the genitals and loins should 
be constantly applied, and he should take exercise in the open air: the diet 
should be nutritions, and the bowels should be kept moderately open by cooling 
aperients; but the tincture of cantharides is the most effectual cure. I have 
long been in the habit of giving this medicine, in doses of from 20 to 30 drops, 
three times a day, increasing or (^'minishing them, according to their effect." 

Inebriety is stated to be a frequent cause of sympathetic insanity. Some, 
it is true, become insane by the irritation and excitement of the brain 
itself, but others, from sympathy with t!ie disorders of the chylopoietic 
viscera, engendered by tlie intemperate use of intoxicating liquors. De- 
lirium tremens is often the precursor of insanity. The excessive use of 
opium is followed by similar efTects, as tliat of spirituous liquors. Inanity, 
or long abstinence from food, is mentioned as a cause of mental derange- 
ment. Gout and dropsy, it is observed by the author, are named as such 
by other writers. No cases of the kind have come within his observa- 
tion. He has seen many cases in which dropsy has supervened upon the 
mental disorder. We would suggest llie probability that, in all these 
cases where the two diseases exist, contemporaneously, so far from either 
being produced by the other, they botli owe their origin to an identical 
cause. It is a well established truth, that any disease which presents a 
considerable obstacle to the portal circulation, may induce ascites. Ac- 
cording to our author, insanity may spring from the same cause. We 
believe the probability to be much greater tliat they both have their origin 
in it, ihan that one of them is induced by the other. 

Symptoms of Insanity. To enter into the minutiae of detail in this 
subject were to penetrate the devious windings of a labyrinth, the termina- 
tion of which could never be reached. The author of the work before us, 
as consistency required, has based his remarks on the symptoms of the 
disease, upon the theory which he endeavours to maintain. We abridge 
from his work. In cases o^ organic lesion of the brain, the first symptoms 
are, a confusion of the intellectual faculties, obtuseness of the senses, em- 
barrassment in speaking, and difficulty of articulation. The lesion in- 
creasing, a torpor of the limbs, and an indisposition to muscular exertion 
supervene. The circulation is languid: there is great congestion of the 
vessels of the extremities; the feet and legs, generally the most affected in 
this respect, are cold, purple, and often osdematous. E;uacialion and 
xleath ensue. 

Arising from slow, spontaneous inflammation of the brain or its me- 
ninges, insanity is generally preceded by severe and continued pain in 
some part of the encephalon, this pain being increased by mental exer- 
tion. The ideas are transient and disconnected, there is no power of con- 
trolling the thoughts, the senses are sometimes very acute, particularly 
that of audiiion. The disease fairly established, its symptoms are those 
oi moral insanity. 

Ellis on Insanity. 103 

In moral insanity, the first anormal indication, in a great proportion of 
cases, is absiradion of mind. The duties of life are neglected, abstraction 
is so great that the patient is with difficulty arou^sed to a consciousness, and 
very soon relapses; the mind dwells upon subjects diverse from those 
addressed to the senses. Seized at this juncture the disease may be ar- 
rested, as is illustrated by a case of threatened relapse, in which leeches 
to the temples, the head shaved and kept cool by cloths dipped in cold 
water, warm pediluvia, and a cathartic of calomel and extract of colocynth, 
produced relief. These were followed by rhubarb, soda and ginger, in 
small doses, three times a day, during two weeks, when the patient had 
entirely recovered. 

Insanity arising from joy or success, displays itself in vivacity of 
demeanor, continued talking and extravagant ex|)ressi()ns of hope. Occa- 
sioned by sympaih}; with tiie chylo[)oie!ic viscera, the premonitory symp- 
toms are dyspesia and hypochondriasis. The disease being established, 
the symptoms vary according t(» the character and temperament of the 
patient. A constant sus[)icion and an aversion to nearest and most inti- 
mate friends, are ihe most frequent. Religious delusions, injaofiuary sub- 
jection- to the power of witches, tiie supposition of venereal disease in 
themselves, exalted ideas of their own importance and abilities, and a sui- 
cidal propensity are among the other symptoms under which these delu- 
ded patients suffer. Many cases of suicide arise from the brain sympa- 
thising with the liver, wlieti that organ is diseased. A tendency to sui- 
cide has frequently commencetl in the last stages of consumption, in those 
cases in which insanity and phthisis puluionalis alternate with each other. 
A siugidar expression of countenance, particularly in the eye, which lias 
bet-n mentioned by autliors as existing in those patients prone to suicide, 
is accounted for by the fact that the muscles ol ex[)ression iiulicate, to a 
certain extent, the feelings of the heart. Hanging has been the mode by 
which most of the suicidal patients at Wakefield and Hanwell have at- 
tempted self-destruction. Much thought and consideration are said to 
have been generally bestowed u|)on the manner in which they should con- 
sum. nate their intentions; and cases are related to show that if they have 
once decided upon a particular method, it is improbable that they will 
adopt any other. Suicides sometimes appear to occur from the impulse of 
the moment, no previous pro[)eiisiiy to the deed having existed. The 
character of patients, in regard to their passions and j)ropensities, fre- 
quently undergoes a great change after the invasion of insanity. The 
amiable become vicious, mischievous, violent, and the modest, immodest. 

Irregularity of secretions, in the early stages of mental alienation, is 
mentioned as the principal physical indication of the disease. But in 
cases where the abnormal action of the cerebro-spinal system has been 
severe, bodily weakness and disease are always present. The tempera- 
ture of the head is very frequently higher than that of any other part of 
the body, and, accompanying this, there is generally, but not invariably, a 
quickened pulse. The extremities are generally cold. In many cases 
there is a cold, clammy, fetid perspiration which makes the body" appear 
as if rub -ed with grease. This varies in the same patient and is most 
apparent during a paroxysm. Dr. Ellis recollects no instance of the reco- 
very of a patient who had this symptom. The tepid bath very much 
destroys the unpleasant feior. 

164 Reviews. 

Extreme hunger and obtuseness of nervous sensibility are frequent 
symptoms of insanity. Intense visceral disease has, in some cases, exist- 
ed, without manifestation during life. The sensibility of the nerves of 
the s[)ecial senses is sometimes very much diminished, at others as greatly 

Idiocy and Fatuity. — In treating of these, the author makes the same 
distinction that Prichard and some others have made, in restricting the 
term *' idiocy" "to those cases where the deficiency of understanding is 
congenital." *'I make this distinction," he observes, "because many 
patients, during attacks of insanity, exhibit appearances so closely resem- 
bling idiocy, that they are often considered incurable and allowed to sink 
without an effort being made for their recovery. But no case, however 
apparently desperate, unless connate, will justify the neglect of the most 
strenuous exertions. Several cases under my care have recovered, where 
the patients have, on their admission, exhibited a total deprivation of all 
the mental faculties." Two interesting cases of this description are re- 
ported, but they are too long for insertion here. 

Idiocy arises from the brain being "defective in size and power," or 
*' from a brain of natural size having some organic disease or mal-forma- 
tion." " Idiots are frequently subject to epilepsy," and, according to the 
experience of the author, " they are not long-lived." 

Fatuity is traced to three causes, viz: long-continued, over-exciting ce- 
rebral action; " weakness arising from excessive general bleedings and 
evacuations in cases of mania," and "masturbation." The last is said to 
be " by far the most usual cause." 

Treatment. — In the introduction to the chapter upon treatment, the au- 
thor declares the impossibility of prescribing a method which might be 
applicable to all cases. Diversity of constitution renders a variation of 
practice essential, even when the causes and the symptoms are identical. 

Insanity being a disease of the cerebro-spinal system, the author divides 
its subjects, in reference to treatment, into two classes: Isl, those "whose 
diseased action only is going on in the brain;" and, 2d, those in whom 
"the continuance of the diseased action has produced diseased organiza- 
tion." The former state he calls "incipient," and the latter "chronic" 
insanity. Cure, or "much relief," can be effected in those cases alone 
which belong to the former class. He objects to the customary division 
into " mania and melancholia," because these " are but symptoms and re- 
sults of over-exercise of different mental faculties; and they are alike at- 
tended by excess of sanguineous circulation in the brain." He concludes 
that the disease, excepting those cases which result from a loss of blood, 
defective nutrition, or other debilitating causes, invariably commences with 
this excess of circulation, and, from its continuance, an organic lesion of 
the brain and its meninges, and effusion of serum in the ventricles and be- 
neath the membranes, eventually take place. Fatuity and death he believes 
frequently to result from too copious venesection, with the intention of 
obviating the determination of blood to the brain, and without an endea- 
vour to remove the cause of that determination. The treatment in the 
latter respect depends upon the nature, either physical or moral, of the 
primary cause. 

Incipient insanity, attended with excess of sanguiferous circulation in 
the encephalon, is divided into, 1st, " Cases where it is produced by a direct 
physical injury, or by some sudden increase of general sanguiferous cir- 

Ellis on Imanity, 165 

dilation, arising from a temporary cause;" 2d, " Cases where the brain is 
principally affected by the action of some moral cause;" and, 3d, "Cases 
where the insanity is caused by the brain sympathising vviih some other 
disordered organ." Those cases arising from an "inadequate supply of 
blood to the brain," are next treated upon. These include such as are the 
result of masturbation, which diminishes the flow of blood in the cerebrum 
and increases it in the cerebellum. The treatment of chronic insanity is 
subsequently discussed. 

Insanity arising from Blows on the Head, Coup de Soleil, c^'C. — The 
symptoms being " an altered manner in the conduct or sentiments, a wild- 
ness of expression, irritability of manner, foul tongue, costive bowels, a 
quickened pulse and sleepless nights," he recommends depletion. " 0»> 
pious bleeding from the temporal artery, free purging with calomel and 
extract of colocynlh, and cold applications to the shaved head, are the most 
to be depended upon," with nitrate of potassa in ten gram doses, nausea 
by tartar-emetic, and heat, or even mustard poultices, if necessary, to the 
feet. The patient's apartment is to be well ventilated, and noise and light 
excluded. Inflammatory action continuing, local bleeding and digitalis, 
with nitrate of potassa, may be directeil. But the author observes that he 
has seen "serious consequences" result from the injudicious use of digi- 
talis, and that "from tive to ten drops [of the tincture?] repeated three or 
four limes a day, is as much as we ever begin with." If, after this treat- 
ment, tiie debility is such as to prevent the healthy process of digestion, 
he recommends bitters, stimulating tonics, and exercise in the open air. 
Finally, a cure by these means not having been effected, the further treat- 
ment is identical with that of moral insanity. A case arising from pres- 
sure upon the brain is here reported, whicli, being of so interesting a na- 
ture, we shall present a brief abstract of it. 

A seaman fell from the yard-arm of one of the British naval vessels, 
which was, at the time, in the Mediterranean. He was picked up insen- 
sible, a short time afterwards, placed in a hospital at Gibraltar where he 
remained several months, and was thence carried to England. During the 
whole of this period he lay upon his back, his respiration continued, and 
his pulse was sensible; he could move his lips slightly, when desirous of 
food or drink, and his fingers exhibited a constant automatic motion iso- 
chronous with the pulsations of the heart There was no indication of voli- 
tion, sensation, or the use of the intellectual faculties, the motion of the 
lips being undoubtedly a phenomenon of organic life, caused by sympathy 
with the stomach. In this state the patient was sent to St. George's Hos- 
pital, and, a depression upon the cranium being discovered, he was tre- 
phined, and the depressed portion of bone elevated. The motion of his 
fingers, still corresponding with the pulse, continued during the operation, 
but tliat being completed, immediately ceased, 'i'hree hours afterwards 
the patient raised himself upon his pillow and sat up in the bed. Being 
asked if he felt any pain, he pointed to his head. In four days he began 
to converse, and could get out of bed. He had been perfectly insensible 
during a period of more than thirteen months. He remembered being 
pressed on board the ship in which he was at the time of the accident, but 
of every thing that had occurred between that time and the day of the 
operation, he retamed not the slightest recollection. 

Diseased action of the brain resulting from long exposure to heat and 
to the rays of the sun, without actual coup de soleil, is to be treated in 

166 Reviews. 

the same manner as if this latter effect were actually produced. Sir W 
Ellis has seen no advantage accrue from the application of blisters to the 
head. *' They appear rather to create irritation than to allay it." Ice, 
or cold water, " has often the most salutary and instantaneous effect." 

Protracted intoxication produces the only cases of insanity which are 
attributed to an excess of sanguiferous circulation, the result of a " tem- 
porary cause." If the patient be strong, his system not debilitated by 
long intemperance, the same treatment as in the foregoing cases is recom- 
mended. If active mania exist, confinement will be necessary. A pair 
of wide canvass sleeves, connected by a broad shoulder-strap, and the 
parts covering the hands made of leather, are preferred to the strait-jacket 
for securing the arms. For the feet, a couple of leathern straps, lined 
with wool, placed around the ankles and secured to the bed by staples, are 
recommended. An arm-chair, each arm being a padded box, and a board 
passii\g between the two, in front of the patient, is a convenient mode of 
confining the body. 

Moral Insanity. — The treatment of this disease is divided into medical 
and moral. It is observed that " in all cases of insanity arising from moral 
causes, on the commencement of the diseased action of the brain, more or 
less disorder will be found to exist in som.e of the other bodily functions." 
It may be in those of one of the abdominal viscera, and, in this case, the 
motle of treatment is to be such as is usual for the same visceral complaint 
under ordinary circumstances. 'Vo diminish the circulation in the brain, 
great depletion is deprecated, on the ground that the brain, or some portion 
of it, being continually over-excited, such general depletion will not with- 
draw the proper proportion of blood from that organ. It is proposed to 
shave the head, and practise topical bleeding upon the scalp directly 
beneath which the excess of circulation is going on. If one spot be more 
painful or indicate a higher temperature than any other, the bleeding should 
be practised there. " In many cases," says the author, " where the in- 
sanity has been clearly confined to particular propensities, / have found a 
greater degree of heat in the scalp covering that region of the brain 
which phrenologists have assigned as the organs of such propensities^ 
than in other parts of the scalp.''^ And, by a species of inductive reason- 
ing, with the assistance of arguments drawn from analogy, the treatment 
of other cases is arrived at. " In other cases, therefore," says the author, 
*' where tlie patient is silent, if I find from the conduct that a certain set 
of feelings and propensities is deranged, I apply leeches or cupping- 
glasses to the region pointed out by phrenologists as their organs.'' And 
this treatment " has been very generally successful." In many chronic 
cases, also, relief has been obtained from local depletion applied on the 
same principles. 

After the topical bleeding there should be refrigeration by cold applica- 
tions, of which ice is the best. The sho^ver bath, which is used by some, 
is thought not to be so beneficial as a continued application of cold. The 
feet are to be kept warm, and mustard poultices applied, if necessary. To 
allay irritation, prevent watchfulness, or induce sleep, exercise and cold 
applications to the shaved head have been found useful. So also has the 
extract of hyoscyamus, or the tincture of digitalis; the former in doses of 
five grains, and the latter in doses of from fifteen to twenty drops. Opium 
is said to be " rarely admissible in insanity," from the fact of its pro- 
ducing heat and febrile action. 

Ellis on Insanity, 167 

We believe the truth of this assertion to be disproved by the treatment 
pursued in some of the lunatic Asylums of this country, where, if we mis- 
take not, opiates are administered with very considerable freedom. The 
following draug-ht, according to Sir W. Ellis, has proved beneficial. R, 
Misturae camphorae ^i; liq. ammonic. acetalis ^ij; tinct. digitalis ti\^xv; 
tinct. hyoscyami ^ss; syr. balsami 3j. Misce. The warm bath, however, 
is the most generally productive of a happy result. If the stomach be 
foul, give an emetic. If the bowels be torpid, and the urine diminished 
or anormal, give purgatives in small, and, if necessary, increasing doses. 
Croton oil, in portions of from one to two drops, at intervals of six hours, 
may be necessary in order to produce free evacuations. To increase the 
renal secretion or diminish the circulation, the following recijie has been 
found useful. R. tinct. digitalis; tinct. scilla^ aa^ss; vin. aniim. tart.; 
spir. aether, nitr. aa^j. Misce. Administer in dose of thirty drops, three 
or four limes a day, in conjunction with ten grains of nitre. If the skin 
be hot and dry and the secretions deficient, give " five grain doses of nitre 
with a quarter or an eighth of a grain of tartar emetic." If the bile be in- 
sufficiently secreted, the following may be used as a substitute for the 
last. R. pulvis antimonialis gr. ij; hydrargyri sub-mur. Misce. It 
is acknowledged that the above method of treating the irritability of inci- 
pient insanity is "slow and uncertain." And the author has "very little 
doubt that there is in nature, some medicine, with which" he is "at 
present unacquainted, that would operate as a specific in these cases." 

Moral Treatment. — To remove the excniing cause of the disease is the 
first indication. Inasmuch as the method of effecting this depends upon 
the nature of the cause, the proper means of accomplishing it must be left 
to be decided upon by the person who has charge of the patient. An 
attempt should be made to interrupt the train of thoiight, and everything 
tending to recall painful associations or reflections should be avoided. 
The patient should be surrounded by new ohjecls and removed from the 
society of his friends. His attention should be drawn to proper amuse- 
ments Efnd to manual labor. 

It is unessential, nay, it would be superfluous, for us to enter into a 
detail of the minutias of moral treatment, recommended by the author 
whose work we have under consideration. The whole fabric of this part 
of his treatment is based upon the same ground, indeed, it is identical in 
all its principal parts, with that of most of our Lunatic Asylums. He 
considers it best that the patients should be placed at institutions devoted 
to the cure of mental disorders, and says that, in the government of them, 
their tastes and habits are the lever, and frequently the only lever, by 
which the moral man can be moved." "So important," he continues, 
"do I consider the diverting the mind by employment, that, when the 
patient cannot be induced thus to occupy himself, or where the occupa- 
tion is too mechanical to keep the mind interested, I do not hesitate, with 
proper precautions to entrust him with tools, even where an inclination to 
suicide or to violence exists. And although 1 have adopted this plan in 
numbers of cases, no accident has yet ensued, and it has frequently been 
the means of the patient's complete recovery." For persons in the higher 
classes of society, he says "A mansion should be provided, with a park, 
woods, lawns, hot-houses, gardens, and green-houses. It should befitted 
internally with every convenience and luxury for the gratification of the 
taste. Science and the fine arts ought to be pressed into the service of 

168 Reviews, 

stimulating the dormant faculties to healthy exercise.'* He proceeds to 
recommend a music-room, a weekly *' dress-concert or oratorio," lectures 
on chemistry with practical experiments, an orrery, a modellinjj room and 
a studio, the study of hotany — various animals and birds both wild and 
domestic, and a good but judiciously selected library. Indeed, he would 
make such an asylum an almost com[)lete college, and he says, '*I should 
not consider that an asylum for the rich had attained the highest point of 
moral management, until it had become so happy a place of residence that 
the patients, when restored, should regret the quitting it, unless drawn 
from it by ties of family and affection." Unfortunately for the welfare of 
the insane, institutions so nearly perfect will probably, for the present, 
like the "chateaux en espagne" of the visionary enthusiast, be found only 
in the fairy land of imagination. 

Insanity from Sympathy. — If the disease originate in a disorder of the 
chylopoietic viscera, the secretions of those organs must be restored by 
the customary means. Profuse venesection is rarely admissible, and, in 
the commencement, neither violent medicines nor large doses should be 
administered. In other respects, the treatment is to be nearly the same 
as if the patient were sane. If there be pain or unnatural heat in the head, 
cold applications and local depletion may be employed, but with care. If 
the disease arise from suppressed natural evacuations, these must be re- 
stored; if from the stoppage of accidental discharges, they must be repro- 
duced. In young and healthy persons, whose insanity has been occasioned 
by intemperance, the head must be kept cool, ihe blood diverted to the 
extren)ities, the bowels kept open, and the irritation allayed by efferves- 
cing draughts and sulphate of magnesia in small doses. A mild tonic 
should be administered after the incipient stage has passed off". When the 
patient is aged, or has been long intemperate, some stimulus is required. 
Brandy has been used with benefit. 

Puerperal insanity seldom occurs, previous to delivery, if the secretions 
of the abdominal viscera continue in their normal condition. A morbid 
state of these, together with sympathy between the uterus and brain, is 
recognised as the cause of the disease. It is generally attended by some 
inflammatory action, and hence requires depletion and other antiphlogistic 
remedies. These are to be used with caution. When insanity supervenes 
after parturition, the lacteals and other secerning organs are defective in 
action and must be restored. " The warm bath, diaphoretics, gentle 
aperients, camphor mixture combined with tincture of digitalis or tincture 
of hyoscyamus, is often very useful in procuring sleep, but shaving the 
head and perseverance in the ap[)lication of cold, are the best means of 
lessening the irritability in this, as in every stage of acute insanity." If 
the disease be produced by excessive hem(*rrhage, tonics, a mild but nutri- 
tious diet, and moderate exercise in the open air, are the proper means of 
treatment. The bowels should be kept open, and all excitement avoided. 
A tendency to suicide and an indiff"erence on the part of parents towards 
their children characterise this form of insanity; and hence a watch should 
be maintained over the former, and the latter removed beyond their power. 
f' Insanity in which the Brain receives an Insufficient Quantity of Blood. 
If this form of the disease arise frou) inanition, the bowels are torpid and 
the piijse feeble, accompanied by general languor. The botlily vigour must 
be restored, and a nutritious, but not a siiuudciting, diet resorted to. The 
head must be kept cool, and, it" it be hot, topical bleeding practised upon 
it. Arising from hemorrahges, the disease is treated in a similar manner 

Ellis on Insanity. 169 

to that from the same cause mentioned under the head of puerperal in- 

Chronic Insanity, — Although, in cases of organic lesion of the brain, a 
complete restoration of the cerebral functions to a normal state is impos- 
sible, yet, v\ here that lesion is very light, the change produced by it is so 
trifling that the patient " is capable of managing his affairs;" and, if freed 
from excitement, may exhibit no indications of insanity for a considerable 
period. There will always remain, however, a liability to a recurrence 
of the disease, and such attacks in some patients occur periodically, being 
induced by very slight causes. By a judicious diet, they may be much 
delayed. An approaching paroxysm is indicated by heat of the head, 
vitiated secretions, nervous irritability, and a change of conduct. Quietude, 
small local bleedings, and the other remedies mentioned in the treatment 
of incipient insanity, are the proper means of medication, all, however, to 
be directed with greater caution than in the former case. The early direc- 
tion of IochI depletion is very highly commended. In the intervals between 
the paroxysms, a judicious moral treatment is necessary. 

Several pages are devoted to a discussion of the importance of medical 
students studying insanity. The study of phrenology is rec^ommended as 
a useful auxiliary. Besides being of indirect benefit, accordmg to the 
opinion of the author, by »' helping us to a more accurate acquaintance 
with the state of the patient, it may be applied^ directly, to most valua- 
ble purposes. One instance of its use has already been detailed. I cotdd 
mention others, where the mere examination of the head, without any 
previous knowledge or information whatever us to the habits of the pa- 
tient^ has suggested the propriety of a particular course of moral treat- 
ment which subsequent events have Jully proved to be correct''^ The 
instance alluded to above of advantage derived from phrenology, is men- 
tioned in an earlier part of the work. After having remarked upon the 
importance of ascertaing the ** ruling passion" of the patient, the author 
relates a case in whicfi that passion was discovered to be "a love of gain." 
*' In this instance," says he, " phrenology was of practical use. The ex- 
istence of the strong feeling of love of gain was ascertained, solely by 
the observation of the head at the time.'' 

Whilst we are willing to admit that a knowledge of phrenology may be 
beneficial to those wlu> are devoted to the management of the insane, still, 
in its present imperfect stale, it appears to us impossible that, to the gene- 
rality of persons, it could be of so eminent /^rac^ica/ utility as is supposed 
by our author. 

i\ir. E. objects to patients being permitted to see their friends. *'Iii 
numerous instances," he says, "patients who were apparently recovering 
very speedily, have been thrown back nearly into the sanie stale as on 
admission, merely from seeing their friends." 

apoplexy. Epilepsy, and the Diseases of the Insane. — Apoplexy is con- 
sidered " to be a variety of that disease of the brain and nervous system 
whicn produces insanity in one person, epilepsy in another and convul- 
sions in a third," rather " than a frequent direct cause of insanity itself." 

Insanity succeeding apoplexy is nearly always fatal, the inieguuients 
losing their vitality and extensive sloughings taking place. Produceil by 
epilepsy, ths disease is but little less incurable. JSetons, blisiers, emetics, 
cathartics, venesection, sedatives, mercury and numerous other means of 
treatment which have been resorted to, have been attended, in the author's 

No. LI.— May, 1840 15 

170 Beviews. 

experience, by no beneficial effect, when the ** seat of disease appeared 
in the head." Strict diet, the avoiding of mental irritation, and the keep- 
ing of the bowels soluble, will often diminish the frequency and the vio- 
lence of the paroxysm. If the epilepsy arise from teething, worms, or 
other sources of abdominal irritation, the removal of the cause will effect 
its cure. Other diseases by which the insane, in common with people in 
general, may be attacked, are to be treated as if there were no mental alie- 
nation, excepting that the remedies, especially depletion and the vegetable 
poisons, should be employed with greater caution. 

The Construction of Asylums and their Mode of Management. — A long 
chapter is devoted to this, which may be consulted with advantage by all 
those who are interested in the subject. 

The distinction between Conduct which is the result oj Moral Evil and 
that which arises from Insanity. — The substance of the author's remarks 
under this head, so far as they are applicable in practice, is contained in 
one or two sentences. He (ibserves that, by some people, *' even where 
no physical disease exists, acts are committed so entirely opposite to the 
feelings of a good and virtuous man, that he is unable to account for them, 
and he attributes them, from kind but mistakeu views, to insanity. But 
such acts differ, essentially, from those which arise from mental derange- 
ment; they are not the result of any morbid action in the brain^ or ner- 
vous system, or of any diseased organisation there; and they are entirely 
optional." ******] cannot think that any act, however vicious 
or eccentric, ought to be considered as the result of insanity, unless ii is 
involuntary and arising from some disease in the brain and nervous 

In the tenth and last chapter of his work, the author discusses the ques- 
tion '* how far the circumstances which produce it (insanity) are either 
directly or remotely under our control?" He examines the several causes 
in succession, and, from his observations thereupon, we glean that, in 
order to abstract ourselves as much as possible from the liability to mental 
derangement, we must avoid exposure to the sun with the head uncovered, 
cultivate presence of mind, wherewith to be able to prevent accidents or to 
mitigate their consequences, observe " that commandment which bids us 
not to make haste to be rich," temper our grief and curb our ambition, 
avoid the gratification of the senses, manage the constitution judiciously, 
have the mind imbued with right motives, and place a proper estimate 
upon the things of life. These things are to be taught to our children, 
and, we may add, •» to our children's children even unto the seventh gene- 
ration." There is much pertinence in the author's remarks upon these 
subjects, but we fear that, in the present state of society in the enlightened 
world, they will be unproductive of much lasting benefit. For the accu- 
mulnti(ui of wealth, and for the " gratification of the senses," people will 
probably continue, as they heretofore have done, to put in jeopardy not 
only their reason but also their lives, 

P. E. 



Art. XVI. An Inquiry concerning the Diseases and Functions of the Brain, the 
Spinal Cord, and the Nerves. By Amariah Brigham, M. D. 12mo., pp. 327. 
New York, 1840. 

The object and plan of the present work are, to adopt the languag-e of the 
author, "to call the attention of those practitioners of medicine into whos6 hands 
it falls, to the importance of the nervous system, and to persuade them to em- 
brace every opportunity that is presented for studying its functions and diseases. 

"For this purpose," the author remarks, "I have endeavoured to give a par- 
tial summary of what is now known respecting this system. I have collected 
a large number of cases explanatory of its diseases and functions — cases that 
are scattered through many volumes; to which I have added a considerable num- 
ber that have fallen under my own observation: and have thus sought to indicate 
the way that this system should be studied in order to increase our knowledge 
of its functions and our means of remedying its diseases. 

"In the second part, I have briefly treated of a number of diseases, the pa- 
thology of which is not yet settled. I have not sought to give full accounts of 
these, but to direct attention to a few important circumstances, and such as re- 
quire further investigation." 

The general plan of the work is a good one, and it has been very successfully 
carried out. It presents a tolerably accurate though somewhat hasty sketch of 
the present state of physiological knowledge in relation to the brain and ner- 
vous system, illustrated by a number of judiciously selected cases of disease 
affecting various portions of the brain, spinal cord, and nerves, and which are, 
at the same time, well adapted to elucidate the leading outlines of the pathology 
of the nervous system. This division of Dr. B.'s inquiry might, it is true, have 
been digested with a little more care, and those particulars connected with the 
physiology of the nervous system that are to be considered as fully established 
more clearly distinguished from such as are as yet merely conjectural, or which 
require for their elucidation further observations. One or two errors, which it 
is unnecessary here to particularise, have been admitted, and we notice a few 
omissions, more especially in reference to the structure of the nervous fasciculi 
— the nature of their primitive fibres, and the positive absence of any anasto- 
mosis or connection between them — the structure of the sympathetic nerve, &c., 
a knowledge of the facts in relation to which are essential to a correct under-- 
standing of the pathology of a large and important class of diseases. 

A reference to the admirable sumniary given by Professor Miiller of the phy- 
siology of the nervous system, would have furnished Dr. Brigham with many 
useful hints, as well in relation to the materials as to the arrangement of his 

The second part of the Inquiry contains a very brief but at the same time 
interesting account of the principal diseases that have their seat in the brain and 
other parts of the nervous system. The only fault of this division of the work 
is its extreme conciseness. 

We can with great confidence recommend the work of Dr. Brigham to the 
favourable notice of the profession. The practitioner, in common with the stu- 
dent, will find it a convenient and very useful manual of the physiology and 
pathology of the nervous system. 

172 Bibliographical Notices, 

If it should be the means of inducing "but a few to investigate the affections 
of this system with care — to record and make known the facts they observe, 
and thus add something to our knowledge of its functions and diseases," as the 
author hopes it may, it will prove a much more useful work than are many of 
those already published on the same subject, although of far higher pretensions. 

D. F. C. 

Art. XVII. New Remedies.- the Method of Preparing and Administering them; 
their Effects on the Healths/ and Diseased Economy, ^c. By Robley Dungli- 
soN, M. D., M. A. P. S., Prof, of Inst. Med. and Mat. Med. in Jeff. Med. 
Coll. of Philada., &c., &c., &c. Philadelphia, 1839. Lea & Blanchard. 
8vo. pp. 503. 

There is manifestly no acquisition more essential to the practitioner, than a 
thorough acquaintance with the properties of the various remedial agents which 
he employs — their effects on the animal economy in health and disease, and the 
best method of administering them, so as to secure the effects we desire. Every 
attempt to assist the physician in the attainment of such knowledge is entitled 
to favour, and such, we are persuaded, will be the reception of the volume just 
prepared by Dr. Dunglison. The aim of the author is " to enable the profession 
to form an accurate estimate of the value of remedies of more recent introduc- 
tion, or of the older remedies whose use has been revived under novel applica- 
tions." These remedies are arranged alphabetically — their synonymes are first 
given — next the best methods of preparing them — then their effects on the eco- 
nomy in health and disease, according to the experiments and observations of 
various practitioners and experimenters — and, finally, formulae for the most 
approved methods of administering them. 

The following article, extracted at random, furnishes a fair example of the 
plan of the vv^ork, and the manner in which it is executed: 


" Synonymes. — Fuligo Splendens, F. Ligni, Soot, Woodsoot. 

*' French. — Suie. 

" German. — Glanzruss, Spiegelruss, Kaminruss, Ofenruss, Russ. 

"The discovery of creosote, and its extensive application to the treatment of 
disease, gave occasion to the resuscitation of this article — much employed by 
the ancients, but subsequently fallen into oblivion. 

"The older physicians frequently used soot as an exciting, diaphoretic agent 
in cachexia of every kind, in chronic rheumatism, cutaneous affections, and es- 
pecially in the evil results of their sudden repercussion; in glandular indura- 
tions, rickets, exostoses, &c. It has also been employed as a domestic remedy 
in colic, and in the simple and dysenteric diarrhoea, and cholera of children. 
Several modern recommendations— as by Schiitte and Weisenberg — remained 
unheeded until the attention of physicians was recently drawn to it, especially 
by Blaud.* He is of opinion, that the costly— and by no means easily pre- 
pared — creosote may be wholly replaced Hy soot. Both are products of the dry 
distillation of organic substances; their odours are analogous, and as soot is 
much cheaper and more easily obtained, it deserves, he thinks, to be tried more 
extensively in therapeutics. The soot has a nauseously empyreumatic, more or 
less bitter and acrid, saline taste. 

"Effects on the Economy. — Blaud f has exhibited the soot in different dis- 
eases, especially in the form of ointment, or in decoction, with excellent and 

* Revue Medicale, Juin, 1834, et Janvier, 1835, and Dr. E. Grafe, in Grafe und 
Walther's Journal, xxiii. 310. Berlin, 1835. 

t Journal des Connaissances Medico-Chirurg., Mai, 1834. 

Dunglison's New Remedies, 173 

rapid effects, in herpes, itch, tinea, gatta rosacea, and pruritus vulvae; and he 
asserts, that he even healed a cancer of the breast by fre^juent ablution with a 
tepid decoction of it, and an ointment composed of equal parts of lard and soot 
with one-eiffhth part of the extract of belladonna; but the same applications 
were of no benefit in a case of cancer of the nose, and in one of cancer of the 
uterus. He also cured a scabby eruption of the mucous membrane of the nose 
by an ointment of soot. In diphtheritis, he used, in two cases, a decoction of 
soot as a mouth-wash with the best effects. 

In confirmation of Blaud's remarks, Voisin asserts, that he cured a case of 
cancer of the face by the soot ointment. 

Dr. J. R. Marinus* has found it very efficacious in chronic eruptions (dar- 
tres), and in tinea. 

Carron dn Villardsf advises a colly rium prepared from soot in cases of stru- 
mous ophthalmia. He infuses two ounces of soot in boilingf water, filters and 
evaporates to dryness; the shining residuum is then infused in very strong boil- 
ing vinegar, and to every twelve ounces of the liquid, twenty-four grains of ex- 
tract of roses are added. A few drops of this solution, in a glass of tepid water, 
form an excellent resolutive collyrium, which may be made stronger or weaker 
at pleasure. He has, also, in cases of spots on the cornea, used soot — either 
blown into the eye alone, or mixed with powdered sugar-candy, and has seen 
good effects from it. United with butter it forms an eyesalve, not inferior, he 
says, perhaps to any other. As, in the treatment of specks on the cornea by 
dropping laudanum into the eye, the organ quickly becomes accustomed to it, 
Carron du Villards advises, that the eye should be excited to a more lively ac- 
tion by means of the combination of soot and tincture of opium given below. 
It is, he says, an energetic agent and may be applied by means of a pencil to 
the granulations of the cornea. He likewise recommends a decoction of soot 
as an injection in discharges which are the consequence of chronic inflamma- 
tion of the vagina. 

More recently, M. Andre Gibrin,:|: has detailed to the Academic Royale de 
Medecine of of Paris, six cases of chronic inflammation of the bladder in which 
soot was beneficially used in the way of injection. He took from the chimney 
two ounces of compact soot, broke it up, washed it, and boiled it in a pound of 
water. The decoction was filtered through paper, and injected into the bladder 
twice a day. The good effects supervened so closely on the administration of 
the remedy, that there could be no doubt as to the cause. The pain ceased, and 
the patient obtained sleep, to which he had been for some time a stranger. The 
urine gradually became clear, and recovered its natural appearance. 

To these remarks it may be added, that, according to Schutte, an ointment 
composed of two parts of fresh butter or hog's lard, and one part of soot, is a 
popular and efficacious remedy on the Rhine for cases of porrigo, itch, and her- 
pes; not more than a dram Qdrachm] being rubbed in at a time. W eisenberg 
ascribes to the soot a protective power against contagious affections of the skin, 
and recommends, especially, lotions of soot water — partly as a preventive agent, 
and partly as a therapeutical application in itch. 

But the soot has not been used, of late, externally only; its internal use, in 
the form of the old '' tincture of soot," has been revived. This was long known 
under the name of "soot drops" and "fit drops," and was employed as an anti- 
spasmodic in hysterical and other affections; but its employment has been ex- 
tended, and it is given in chronic rheumatism, chronic affections of the chest, 
suppressed cutaneous eruptions, in many cases under precisely the same notions 
that prevailed years ago. From thirty to sixty drops of the following tincture 
are given several times in the course of the day. 

* Bulletin Medical. Beige, Nov. 1838, p. 28:1. 

t Gazette iVIedieiile, Janvier, 1831; see, also, Baudelocque, on its use in Scrofulous 
.Ophthalmia, in Bulletin General de Therupcutique. Mars, 1634. 
X Bulletin de I' Academic, 15 Mars, 1837. 


174 Bibliographical Notices. 

" Mode op Administering.— Ms^ura Fuliginis, — Tindura Fuliginis {Clau- 
deri.) — Mixture of Soot. 

R. Fulig. splend. ^ss. 

Potassae carbonat. ^iss. 
Ammoniae carb. 3ij. 
Aq. sambuc. ^ix. 
Digere leni calore. Filtra. 
Dose. — From thirty to sixty drops several times a day. 

Lotio Fuliginis. — Lotion of Soot. 

R. Fulig. splend. manip. maj. ij, 
' Coque cum aq. font, tbj per semihoram. Cola cum expressione. 
Used as a wash, several times a day, in herpetic, psoric and syphilitic ulcers. 


Vnguentum Fuliginis. — Ointmeht of Soot. 
R. Fulig. splend. 
Adipis, aa. .^ss. 

Extract, belladon. 5j. M. exacte, 
To be spread upon lint or tents in cases of cancers. Blaud. 

R. Axung. porcin. 

Fulig. splendent, aa. ^ij. 
Coque leni igne per horas vj. 
As a dressing in cases of tinea, and of foul ulcers. Blaud. 

R. Carbon, pulv. 

Sulph. depur. aa. §j. 
Fulig. splend. 
* Cort. Peruv. flav. aa.^^ss. 

Cerati simplicis q. s. ut fiat unguentum. 
A drachm to be rubbed in, once or twice a day, in cases of tinea. 

Cabron du Villards. 

R. Opii,gij. 

Caryoph. arom. ^j. 
Fulig. splend. loti, ^ss. 
Aq.cinnam. ^viij. 
Alcoholis, .^iv. 
Digest in a gentle heat for six days; filter and express the residuum. 
Applied in cases of specks on the cornea. Carron du Villards. 

R. Fulig. gij. 

Album, ovi. No. vj. 
Tere simul. 
As a dressing for herpes and tinea. It is the Pommade resolutive of Saint 

R. Fulig. giss. 

Zinci sulphat. 5vj. • 
Adipis, ^iv. M. 
Applied in cases of tinea. It is the Pommade contre la teigne, of Bories.f" 

We recommend this very useful compilation to the attention of students and 

* Nouveau Formulaire Medical et Pharmaceutique. Paris et Lyon, 1820. 
t Formulaire de Montpellier. Monlpellier, 18'^2. 

Carus's System of Physiology. 175 

Art. XVIII. System der Physiolngie umfassend das ailgemetne der Physiologic, 
die Fhysiulogische Geschichte der Menschheit^ die des Menschen und die der ein- 
zelnen organischen systeme im menschen^ fur naturforscher und aerzte bearbeitet. 
Von Dr. "Carl Gustav Carus, &c., 2 vols. 8vo, pp. 372—460. Dresden, 
1838, and 1839. 

A System of Physiology, embracing General Physiology, the Physiological 
History of Man, and of his individual organs, for the use of Naturalists and 
Physicians. By Dr. C. G. Carus. 

It would be impossible to give to our readers a correct idea of the physiological 
doctrines advanced in the two volumes before us, without presenting a critical 
analysis of the greater portion of their contents. Such an analysis would, 
however, occupy more space than we can well appropriate to a work so essen- 
tially theoretical in its character. Dr. Carus has attempted to construct from the 
comparatively scanty materials at his disposal, a complete system of Biology 
as the foundation of general as well as special physiology. To the theories 
advanced by the author we are willing to concede the praise of ingenuity, and, 
so far as relates to the general facts and observations upon which these theories 
are based, he has certainly exhibited commendable industry in their collection 
and sufficient accuracy in their detail. On most of the points connected with 
the general doctrines of physiology, his observations, it is true, are particularly 
interesting, while many of his views, if they cannot be received as fully esta- 
blished, are at least deserving of attention in consequence of their very great 
plausibility. Dr. Carus has, nevertheless, so intimately blended, in relation to 
almost every subject of which he treats, fact and hypothesis, established truths 
and bold assumptions, as to vitiate, in a great measure, all his leading deduc- 
tions. His entire system of Physiology can, in fact, be viewed in no other 
light than as a splendid hypothesis, highly plausible, we confess, in many of 
its parts, but in others wanting even this recommendation. 

The lime has not yet arrived when any attempt at the formation of a complete 
"System of Physiology" can be expected to be successful. On many impor- 
tant points connected with the functions of the living organism, our knowledge 
is at best imperfect, while in relation to many others we must confess our entire 
ignorance; it is even probable that many of what are nowr considered fully esta- 
blished physiological facts, will be shown by future observations and discoveries 
to be errors, or, at least, to be so essentially modified as to render inaccurate 
whatever system may be attempted to be based upon them. It is only by the 
accumulation of facts, and the further verification of those we already possess 
by judiciously conducted observations and experiments, that the promotion of 
physiology to the rank of an exact science can be effected. 

While the scientific reader may derive from the work of Dr. Carus many 
useful hints, we cannot recommend it to the student of physiology, convinced 
that it would be rather calculated to mislead him than to convey to him any 
positive instruction. D. F. C. 

Art. XIX. Wenhen en Meeningen omfrent Geneeskundige Staatsregeling enAlgc- 
meene Geneeskunde^ onder medewerking van eenige Vaderlandische verzameld 
en Uitgegevendoor J. P. Heue, Practiserend Geneesheer te Amsterdam. 

Jahrbuch der Gesammten Staatsarzneikunde. Herausgegeben von Dr. C. F. L. 
WiLDBERG, Grossherzoglich, Mecklenburg-Strel Ober-Medicinalrath. 

Both these Journals are devoted, the first chiefly and the second exclusively, 
to Medical Jurisprudence and Public Hygiene. 

That edited by Dr. Heije, which, besides the several subjects connected with 
legal medicine, embraces in its plan the ordinary topics of a Medical Journal, is 
published at Amsterdam, and was commenced in March,, 1838; only the firist 
four numbers have been received by us. 

176 Bibliographical Notices, 

Of the Annals of Legal Medicine by Dr. Wildberg, published at Leipzig, five 
volumes have already appeared. 

Both works exhibit a very considerable amount of talent on the part of their 
respective editors and contributors, and, by the dissemination of facts connected 
with the important subjects to which they are devoted, they cannot fail to do much 
good in directing the attention of the profession to the study and improvement 
of every branch of legal medicine. 

The leading articles of both journals are replete with interest, without, how- 
ever, presenting much novelty either in reference to their subjects or the manner 
in which they are treated — many of them are of a strictly local character. 

Among the more important contents of the four numbers of Dr. Heije's Jour- 
nal may be enumerated; — 

On the Influence of Schools on the Health of Children; by the Editor; a very 
sensible paper, comprising many excellent hints for the improvement of the 
physical discipline of schools and the arrangement of the periods of study. 

On the Lesal Provisions in relation to Diseases of the Mind; by the Editor. 
After pointing out the regulations in relation to the Insane of the French Go- 
vernment, and commenting upon their policy and beneficial tendency. Dr. H. 
computes that eight hospitals, each adapted for the reception of three hundred 
insane patients, will be required in Holland. In Friesland there is, according 
to the editor, one insane to every 2739 of its inhabitants, and in Overyssel one 
to every 899. 

On the Examination of Persons adapted to serve as Recruits and Substitutes 
in the National Militia, by the Editor; containing some useful hints on simi- 
lated diseases. 

On the Plague and Quarantines, by Dr. Bussemaker. 

Two Medico Legal Investigations in Cases of Accusation for Infanticide. 

A Review of Schrceder v. d. Kolk's Report on the neglect of the proper 
means for the Alleviation of the Condition and for the Cure of the Insane in 
Holland; an interesting paper, though the remarks it embraces are of an almost 
exclusively local character. 

There were treated in the Insane Hospital at Utrecht, between the years 
1832 and 1837, "^17 patients, of whom 88 were cured. 

On Premature Interments and houses for the reception of the dead previous 
to interment; a paper containing many important suggestions. 

On Vaccination, Varioloid, &c., by Dr. Arntzenius. The writer is a strong 
advocate for vaccination. He believes it to be in all cases when fully per- 
formed an effectual preventive against small pox. When it fails to protect the 
system from an attack of the latter, he believes this to arise either occasionally 
from some peculiarity of constitution in the patient, or more generally from the 
neglect of the physician, in consequence of which the system has not been 
placed fully under the influence of the vaccine virus, and from vaccination being 
frequently performed by individuals wholly ignorant of the distinctive characters 
of the genuine affection. Dr. A. considers it probable that when, after vaccina- 
tion, an herpetic eruption or scrofulous symptoms occur, the predisposition to an 
attack of small pox may not be fully extinguished. He urges revaccination 
after ten or fifteen years in all cases in which there is any doubt as to the full 
protection of the system by the previous vaccination. 

A Review of Dr. Bosch's Treatise on Indian aphthae, {aphthae orienfales.) The 
author denominates the disease a phlegmasia of the mucous membrane of the 
stomach and lungs. The common aphthae he considers to be a strictly exanthe- 
matous disease. He proposes for the cure of the Indian aphthae, gentle laxatives 
with frictions of mercurial ointment over the epigastrium in the commencement, 
and, at a later period, small doses of ^sulphuric acid and tonics, particularly the 
lichen Islandicus, and externally leeches and frictions with a solution of tartar 

In the Annals of Dr. Wildberg, the papers deserving of particular notice are 
the following: — . 

On the necessity of an assiduous attention on the part of the state to the 

Heije and Wildberg on Medical Jurisprudence. 177 

suppression of prostitution and unchastity and the means adapted to that end; 
by the Editor. 

Dr. W., after noticing the increase of prostitution and unchastity which has 
taken place of late years, and the baneful influence which these vices exert not 
only on the individuals addicted to them, but upon society at large, proceeds to 
consider the causes to which their increase is to be attributed, under the follow- 
ing heads: — 

1. The entire ignorance in which the youth of all classes of society are left, 
in relation to the structure and functions of the human body, and, consequently, 
of what is necessary for its health and well being. 

2. The defective education of children, both moral and physical. 

3. The neglect of children, on the part of their parents and instructors, during 
their hours of relaxation and school holidays. 

4. The intimate intercourse of children of different classes of society. 

5. 6. The excessive luxury of the present day, and the prevailing taste for 
pleasure and dissipation. 

7. The great extent to which the perusal of love tales and other improper 
works is promoted hy the numerous circulating libraries and reading rooms, 
and, in consequence, the powerful excitement afforded to the imagination and 
sensual appetites in early life. 

8. The disregard in which marriage is held, and the obstacles thrown in the 
way of its early contraction. 

9. The want of respect for the moral character of men, and the tolerating, 
excusing and holding in equal estimation those of dissolute lives and characters. 

10. The neglect of clergymen in not enforcing the moral obligations opposed 
to prostitution and unchastity. 

11. The neglect on the part of the public authorities of those measures which 
are calculated to prevent and suppress these vices. 

The means proposed by the writer for the diminution and extinction of prostitu- 
tion and unchastity may be inferred from the above enumeration of the causes 
to which he refers its promotion and increase. 

Two excellent papers occur in the third Number from the pen of the Editor; 
the first, on the causes which induce so many mothers to give up the suckling 
of their infants, and the injury which these incur from hired nurses; and the 
second, on self-destruction from intemperance in the use of ardent spirits. 

Advocate Bopp, of Darmstadt, presents a very interesting contribution towards 
the history of legal medicine. 

The various details presented in the communications respecting the legal 
regulations of the Grand-Duchy of Hessia to prevent the too early interment of 
the dead; the provisions of the Duchy of Nassau and of the Arch-Duchy of 
Hessia in relation to legal medicine; and the legal provisions of the latter 
Duchy in regard to the medical attendance of the poor; will be read with great 
profit and pleasure by all who are interested in the subject of public hygiene 
and medical jurisprudence. 

From the general summary of intelligence appended to each Number of the 
Annals, we select the following statistics: — 

In St. Petersburg, there were born in the year 1838, 11,120 children; the 
deaths the same year amounted to 11,711— giving an excess of deaths of 591. 

In Moscow, there were born in the year 1838, 9153 children, and there died 
7967 persons — giving an excess of births of 1185. 

In the city of Posen, with a population of 36,468, there were born in the year 
1838, 1388 children, and there died 960 individuals— giving an excess of births 
of 4-28. So 

In the City and Parish of Elberfeld, with a population of 35,411, there were 
born in 1838, 1726 children, viz: 865 boys, 861 girls— 68 of which were illegiti- 
mate. Twins occurred 14 times, and 97 children were dead born. There died 
the same year 1192, viz: 639 men and 553 women—the oldest of whom was 99 
years, 3 months— excess of births this year 535. 

In the City and Suburbs of Rostock, there were born in 1838, 567, viz: 273 

178 Bibliographical Notices, 

boys and 294 girls — 72 of whom were illegitimate. There died 463 — 243 males 
220 females — excess of births 104. Married this year 137 couple. 

In the City and Suburbs of Vienna, there were born in 1838, 16,296 children, 
and there died 14,393 individuals — excess of births 1903; 3087 of the deaths 
were from diseases of the lungs, 1972 from consumption, and 100 from small 

In Berlin, with a population of 280,000, there were born in 1838, 9429, viz: 
4925 boys and 4504 girls; of whom 1296, viz: 676 boys and 620 girls were 
illegitimate. There were 107 cases of twins and 1 of triplets. The deaths this 
year amounted to 8649— excess of births 780. Of the illegitimate children 789 
died. The suicides amounted to 78 — 2753 couple were married. 

In the Grand-Duchy of Mecklenbcrg-Schwerin, with a population of 482,692, 
there were born in 1838, 18,125 children, of whom 944 were either dead born or 
died previous to baptism, and 2400 were illegitimate. There died this year 
9819 — excess of births 8306. The suicides amounted to 54; 3690 couple were 
married. Of the deaths, there were 1209 of persons over 70—423 of persons 
over 80 —60 of persons over 90, and 3 of persons over 100. 

In the Grand-Duchy of Mecklenberg Slrelitz, in the year 1838— in the Duchy 
of Strelitz, there were born 2403, namely. 1258 bpy* and 1155 girls— 273 of 
whom were illegitimate; 24 cases were twins. There died 1630, namely, 863 
men and 767 women — between 80 and 90, 65 — between 90 and 100, 8; suicides 
11; married 584 couple. In the Principality of Ratzeburg, there were born 539 
children, of whom 55 were illegitimate — 10 cases were twins; there died 323; 
married 145 couple. In the whole of the Grand-Duchy, the births exceeded 
the deaths by 989. 

In Frankfort on the Maine, there were born in 1838, 1176 children, including 
56 dead born — there died 1178 — giving an excess of deaths of 2; 311 couple 
were married. D. F. C. 

Art. XX. Annual Report of the Interments in the City and County of New York 
for the year 1839, with Accompanying Remarks, By William A. Walters, 
City Inspector. New York. 

This is an interesting statistical document. In the construction of the 
tables, the author has followed with some slight alteration the excellent plan 
introduced by his predecessor. Dr. Dunnel, noticed on a former occasion, 
(No. for August, 1839, p. 429.) These tables. Dr. Walters states, are as ac- 
curate as possible, consistent with the requirements of existing statistics; but 
that to furnish exact returns, the bills of mortality should be drawn, not from 
the number of interments, but rather from the actual number of deaths occurring 
in the city. No proper estimate of deaths in proportion to the population, he 
adds, can be given, until we are ftirnished, first, with a register of births; and, 
secondly, with the new census of the city and county, now in course of pre- 

The following remarks of Dr. Walters furnish a synopsis of the principal 
points of interest. 

"The whole number of interments within the city during the year ending 
December 3lst, 1839, were 7953; being 100 less than for the year preceding. 

" Of these, 7491 were from among our white population, and 462 were coloured 

" Of the whole number, 4389 were males and 3564 females. This excess of 
mortality among the male population, as already stated in the reports of inter- 
ments for previous years, is not easily explained, and is probably much greater 
than the proportion of male over female residents. 

*'The disparity commences during foetal existence, as is shown in the table 
of still-born infants, and continues almost through every period of life. 

*' The average mortality among our foreign population appears to be much 

BeWehoid on Duration of Human Life. 179 

greater than among our native citizens. Of the whole number of deaths in per- 
sons over ten years of age, 1419 were natives and 1853 were Europeans. 

"The season of the year most fatal to human life in this city, as shown by 
the tables, is during the months of July, August and September. The season, 
on the contrary, in which the fewest deaths occur, is during the three months 
immediately preceding these, namely, April, May, and June. 

"The great mortality in this city among the children under five years of age, 
has long been the subject of remark. During the past year, exchufing the still- 
born, more than half the deaths, or 3696, occurred in children before the com- 
pletion of their fifth year. The disease most fatal within this period of existence 
are, marasmus, inflammation of the brain, hooping cough, measles, scarlet fever, 
dysentery, diarrhoea, cholera infantum, croup, convulsions, dropsy of the brain, 
and teething. 

" The mortality from pulmonary diseases, including in this list all the dis- 
orders of the respiratory organs, is nearly equal to one-third of the whole number 
of interments. 

"The deaths from pulmonary consumption alone, during the past year, were 
1315, being an increase of 90 over the year preceding. 

"The mortality from pulmonary consumption in this city may be rated at 
one-sixth of all the deaths; but the average varies greatly among the different 
classes. It is worthy of remark, that of those over ten years of age, that die of 
this disease, more than one-half are natives of Europe. Of the 5564 deaths 
among our native white citizens, only 610, or about one in nine, occurred from 
consumption. Of the 462 deaths among our coloured population, 13-2, or one 
in three and a half, occurred from this disease. And of the 1853 deaths among 
our European population, 563, or about one in three and a quarter, occurred from 
the same disease. 

"The city has been visited by no fatal epidemic during the past year; and, 
with the exception of measles, the various contagious diseases have been less 
prevalent than formerly. 

"The tables show 68 deaths from small pox. The proportion of these that 
had previously undergone vaccination cannot be ascertained; but as 38 of them, 
or more than one-half, were among children under five years of age, the proba- 
bility is, that very few of the whole number had resorted to the only efficient 
means of protection against this loathsome and fatal malady." 

Art. XXI. De la Duree de la vie Humaine. Par le Docteur Bellefroid, a 

Hasselt. Bulletin Medicale Beige. Aug. et Nov. 1839. 
On the Duralion of Human Life. By Dr. Bellefroid, of Hasselt. Brussels: 


The mean duration of human life, and the agencies by which this is either 
shortened or prolonged, afford some of the most interesting objects of inquiry to 
the investigator of medical statistics. Much light has of late years been shed 
upon the subject, and the results obtained by numerous inquirers are to be met 
with in the pages of our Journal. It aff'ords us pleasure to subjoin others ob- 
tained by a new author, as these present some novel facts, and at the same time 
serve to correct or confirm the estimates of others. For the methods pursued 
in calculating the mean or average duration of life, we must refer to the writings 
of Halley, Deparcieux, Malthus, ('orbaux, Finlayson and Caspar. The fol- 
lowing comprise some of the interesting facts furnished in Dr. Beilefroid's 

Duration of Generations. — It is generally considered that a generation lasts from 
30 to 33 years, and that three generations are comprised in an age or century. 
This opinion seems to have been confirmed by recent researches made at Paris 
by .VI. Villot, keeper of the Archives of France, from which it results that the 
duration of generations among the male sex has been very nearly 33^ years in 

180 Bibliographical Notices. 

the superior class of Parisians, who have preserved records or other means of 
establishing the point. The duration of a virile generation is, however, esti- 
mated by M. Villot to comprise the period between the birth of the father and 
the birth of his first son, a mode of makina the estimate Dr. Bellefroid very 
justly pronounces improper, although it is in accordance with the common 

"The most general principle which we can establish upon this subject," 
observes Dr. B., "is, that the number which expresses the mean duration of life 
of any people, expresses also the length of its generations. For, suppose the 
inhabitants of a country have, counting from their birth, a mean duration of life 
of 30 years, this would indicate that after thirty years these inhabitants will all 
have disappeared and be replaced by a new generation, which, in its turn, would 
remain 30 years, and that this succession would continue the same until the 
occurrence of some circumstance calculated to alter the cypher expressing, the 
mean duration of human life. In Belgium, the duration of generations corres- 
ponds exactly with the mean of human life, both being 30 years. In our 
country, the whole number of deaths per annum amounts to 102,188 (in 1835 
and 1836), making 279 each day and 11.63 per hour. Dr. Caspar, who has 
had the patience to make a similar calculation for the whole earth, has estimated 
the total population at 960,000,000, and the mean duration of life at 33 years. 
From these data, the last of which is unquestionably too high, he computes that 
29,000,000 die every year, 80,000 every day, about 3300 per hour, and 55 per 

In regard to the influence of sex upon the duration of life. Dr. B.'s investiga- 
tions confirm those made by so many others who have shown that females have 
generally the advantage of males from birth to a very advanced period of life, 
though the difference in favour of the females is greatest in the first year of 
existence. In Belgium, however, tlie advantage which death seems to allow 
the fair sex, does not extend to all classes of society. With females living in 
large towns, the chances of life exceed those for males at all ages from birth to 
the seventieth year. The ratio of this excess is eight years at the time of birth, 
and never less than three up to the sixtieth year It is, however, far otherwise 
with regard to the probabilities of life in the country, where the ratio of mor- 
tality of females remains constantly below that of the males from the age of 
twenty to the latest periods of life. This, it must be remarked, is the case in 
the rural portions of Belgium, and the remark applies with equal force to Ger- 
many, Switzerland, and all other countries where cupidity forces females to 
engage in those laborious pursuits which are suited only to the greater strength 
and rugged ness of the male sex. 

With regard to the dangers incurred by females at what is termed the critical 
age of forty-five. Dr. B.'s researches seem to confirm those of Benoisten and 
others, who have investigated this subject, all of whom have shown that in 
Paris, St. Petersburg, Berlin, and perhaps all otlier places, the ratio of mortality 
at that age is really greater for males than females! 

In adverting to the causes which operate in favour of females. Dr. B. refers 
to that of the greater size of the male at birth. He, however, ridicules the idea 
put forth by Joseph Clarke, that the results of the mechanical difficulties to 
which males are subject at birth, when they do not prove fatal at once, continue 
to exert an unhappy effect upon them to the last days of their lives. Almost 
every one who has attempted to explain the cause of the greater mortality of 
males than females, have ascribed it mainly to the greater exposure of the 
males to accidents of various kinds, and to fatiguing and exhausting labours. 
These external causes, although they doubtless exert some effect, will not suffice 
to account for all the disparity which subsists between the rates of mortality of 
the sexes, and our author, therefore, believes with Dr. Caspar, that the main 
cause of the greater longevity of females is to be sought for in their physical 
organization, which exposes males to greater danger from acute diseases. This 
fact we demonstrated, we believe, for the first time, in the pages of this Journal 
several years agOj as may be seen by referring to the No. for Nov. 1835, p. 56. 

BelMtoid on Duration of Human Life, 181 

Dr. Bellefroid gives, in his third section, some very interesting facts to show 
the agencies exerted by marriage and fecundity upon the probabilities of life. 
Hufeland and Deparcieux were the first authors who affirmed that celibacy had 
the effect to shorten life. The demonstration was however made by Dr. Odier, 
whose calculations, show that a girl of twenty years has the chance of living in- 
creased ten years by marrying, and that up to the ninetieth year, the existence 
of married women and widows is much more secure than that of spinsters. Dr. 
B's computations not only confirm the results of Dr. Odier but make the proba- 
bility of life of a girl who marries at twenty, eleven years greater than that of 
the single woman, a privilege enjoyed throughout the latest periods of life. 

The advantages thus conferred by matrimony, in prolonging the period of ex- 
istence, are not confined to the female sex, but singular as it may seem, are 
enjoyed to a greater degree by men, as will appear from the following extract 
from our author: 

" We have calculated the chances of life of married and single men, by the 
mortuary lists made by Deparcieux from the records of St. Sulpice, and although 
the date of these is somewhat distant they serve to confirm in a great degree 
the results we have obtained from other data. It is shown by these that the 
probabilities of life of married men exceed those of the single by nineteen years, 
at twenty years of age, and that at all periods of life, the married man pre- 
serves a decided advantage of longevity. The difference between the probable 
chances of life is therefore much greater between married and single men, than 
between married and single women. The table of Dr. Casper coincides per- 
fectly with our own calculations upon this point, showing, that at every age, 
from that of pubescence to the cessation of the catamenia, married females enjoy 
a longer and more secure life than the single. But it proves at the same time, 
that the advantage accruing to females from marriage is not near so great as that 
afforded to men: for whilst from the ages of twenty to thirty the mortality of 
husbands is to that of bachelors about as one to twelve, that of wives to spinsters 
is only in the population of one to six during the same period of life. The num- 
ber of spinsters who live to be seventy years old, is only 16 percent, whilst that 
of married women is 34 per cent. This difference, without being so great as 
that existing between married men and bachelors of the same age, nevertheless 
confirms what we have stated in relation to the happy influence exerted by 
marriage upon the latter period of life." 

The disparity observed in the proportional mortality of married men and 
women, is to be chiefly ascribed to the perils of child-birth. 

Influence of Professions and Occupations upon the Duration of Life. — Professor 
Caspar, of Berlin, has published the results of his investigations upon the in- 
fluence exerted on the duration of life, by at least ten professions. Many highly 
interesting facts are developed by these researches, which, however, are con- 
fined to Germany, and to the present century. Dr. Bellefroid, in pursuing a 
similar train of investigation, has pushed his inquiries into every part of Europe, 
so as to show the effects or agencies exerted by differences in climate, manners 
and customs, upon large numbers distributed into particular professions and oc- 
cupations. Nor are these inquiries confined to the present century, but extend 
back so as to embrace at least three centuries. 

In distributing the various subjects of his observations into the respective 
classes, and forming what he terms his social scale. Dr. Bellefroid notes down all 
individuals who have obtained reputation by an exertion of talent, excepting 
popes, such persons as have died by violence, and those whose ages have not 
been satisfactorily determined. He places in his 1st class, kings, queens and 
reigning princes; 2, ministers, ambassadors, governors, &c., comprising those 
in the highest employments; .3, Catholic priests; 4, Protestant, Lutheran, Cal- 
vinist, English and other clergymen; 5, poets, that is to say, all those authors 
the works of whom are rather the products of the imagination than of the reason 
and the memory, such as authors of romances, dramas, &c.; 6, artists, compre- 
hending painters, sculptors, engravers, architects, musicians and actors; 7, sa- 
vans, comprising those who meditate, or compile, such as mathematicians, che- 
JNo. LL— May, 1840. 16 

182 Bibliographical Notices. 

mists, natural philosophers, grammarians, historians, &c.; 8, professors of uni- 
versities and colleges not comprehended in the preceding classes; 9, the military, 
for the most part superior officers; 10, medical men, subdivided into, 1st, such 
as are exclusively devoted to practice, and 2d, those v^^ho devote themselves 
chiefly to the literature of the profession, or to teaching; 11, blue-stockings, 
{bas-hleus) comprehending literary ladies, female artists, actresses, &c.; 12, cul- 
tivators, or farmers and gardeners; 13, merchants; 14, lav^^yers; 15, persons in 
subaltern employments. (The calculations for the four last classes are adopted 
from Dr. Caspar.) Finally, mendicants, that is to say, such of the poor as re- 
ceive aid from charitable institutions, from which class all under twenty-five 
years are excluded. 

Dr. B. observes that it might have been advantageous to make more numerous 
distinctions, especially in the class of artists, since it is ascertained that painters 
are not so long-lived as sculptors, which last are exceeded in longevity by en- 
gravers and architects. Having, however, completed his original plan, it was 
not convenient for him to alter it. It will be seen that most of his inquiries 
appertain to classes of individuals pursuing the less laborious employments. 
With regard to the rate of mortality among those engaged in the more laborious 
pursuits, it may be remarked, that, as a general rule, it is in direct proportion to 
the violence of the labour, exposure and privation experienced. 

As to the prof essions which have been the particular subjects of Dr. B.'s in- 
vestigations, the average duration of life in each is as follows: 
Catholic priests, 68.8 years; Protestant ministers, 65.8. 
The mean duration of life with savans and professors taken together, is 62.1, 
and if the different nations be distinguished, they would stand as follows: 
German savans and professors, - - - 59.9 years. 
Italian " " . _ . - 61.3 " 

Dutch " " . - - - 61.8 " 

English *' " - - - - 62.8 " 

Belgic " u - - - - 63.7 " 

French " " . . _ - 64.6 '' 

The average duration of life with female artists, blue-stockings,' &c., has 
been 61.4 years. 

Physicians devoted to the literature of their profession have lived, on an ave- 
rage, 62.4 years; and when those of different nations are distinguished, they 
stand as follows: 

Those of Holland and Belgium, . - - - 58.6 years. 
Germany, --_--_ 59.5 " 

France, 62.3 " 

Italy, 62.6 « 

England, -.-..- 64.1 " 

With practising physicians the mean duration of life has been much shorter, 
namely, 58.4 years. 

Those of Germany have averaged - - - 55.7 years. 

France " " - . . . 59.5 " 

Italy " " - - - . 58.4 " 

England " " 60.2 " 

The average duration of life with poets and artists, has been 58.2 years. 
When the different classes and professions are viewed in regard to longevity, 
the results are as follows: 

Of kings, but 13 out of 100, attain to 70 years of age, whilst, at that period 
of life, there survive 46 Catholic priests, 41 savans, 37 protestant ministers and 
farmers. At the same epoch of life there only exist 21 objects of charity, 26 
practising physicians, 29 advocates, 30 poets and monastics, and 32 artists, out of 
every 100 — whilst there are 36 of the military profession, 35 persons in the higher 
employments, 34 theoretical physicians, and 33 professors and store-keepers. 

" The general consequences resulting from these estimates are," Dr. B. ob- 
serves, " easy to comprehend. Kings are short-lived because luxury excites, 
ambition depraves, and pleasures exhaust them. Tossed alternately between 
the extremes of anxiety and immoderate pleasures, it is only in retirement that 

Bellefroid on Duration of Human Life, 183 

they can enjoy that repose of mind and body which allows their time to flow 
like the more tranquil current of ordinary life," &c. 

One might be somewhat astonished to see the military profession classed 
among the most favorable in regard to longevity, whilst lawyers do not live so 
long as either artists or poets. But this astonishment will cease when it is re- 
collected that the list only includes superior officers, who are perhaps 30 years 
of age before they have attained an elevated rank. On the other hand, it is not 
uncommon to meet with lawyers at the age of 20, and almost all who join the 
profession do so by the time they are 25 years old, and this serves to explain, 
for the most part, the difference remarked in the longevity of the two professions. 

Dr. Bellefroid concludes his inquiries upon this topic with the following re- 
marks: — " To lead a life which is to endure, one must be neither king nor beg- 
gar, have enough to satisfy the wants of nature, and little that is superfluous. 
He must be regulated by the rules and precepts of piety, possess but little 
imagination, and, as a consequence, be but little troubled with the passions 
and vices. He must not be a physician. The receipt is infallible." G. E. 

Art. XXn. ^n Account rf the Yellow Fever which appeared in the city of Gal- 
veston, Republic of Texas, in the autumn of 1839, loith Cases and Dissections. 
By AsHBEL Smith, M. D., Ex-Surgeon General of the Texian Army. Gal- 
veston, 1839. 12mo. pp. 78. 

This valuable and important contribution to our knowledge of Yellow Fever, 
in addition to the account of the disease given in our preceding No. (p. 499,) 
contains the results of the author's expedience relative to its treatment, and the 
details of thirty-one cases, with the post mortem appearances in eight of them. 

The histories of these cases place beyond doubt the fact of the disease having 
been the same as the yellow fever of the Havanna, and the autopsies show that 
M. Louis is in error in supposing a peculiar discolouration of the liver (See this 
Journal, No. L.p. 384) to be an invariable anatomical character of the disease. 
Evidence to the same point might be adduced from other sources. It may be ob- 
served, however, that the character alluded to is one of very frequent occurrence. 

The following case aflbrds an exception to M. Louis's law. 

We have not space for the history, except to state that the subject was a man 
aged about 45, who died on the commencement of the fifth day of the disease. 

Jiutupsy, six hours after death. "Surface of an intense yellow, with livid 
patches about the hypochondria — fat — body not yet cold. — Lungs exhibit a 
little cadaveric infiltration.— iTear/ sound. 

^^Mdomen, all the organs still warm. The portal vessels are full of blood. 

^^ Liver large, of a mahogany colour, contains in its substance a considerable 
quantity of darkish fluid blood. Gall-bladder small, not distended, destitute of 
bile, contains a small teaspoonful of mucous matter and several dark bottle green 
concretions, varying in size from the head of a pin to a large grain of wheat, 
and having the consistence and tenacity of Tripoli paste. Internal coat of the 
gall-bladder deeply injected and granulated. Biliary ducts are permeable and 
contain a small quantity of thin yellowish mucus. 

" Stomach contains half a pint of black vomit — the flakes are abundant and 
very large. The mucous membrane surrounding the cardia is deeply and evenly 
injected to the extent of upwards of an inch in every direction — this tissue is 
here of the usual thickness and firmness, with a perfectly smooth surface; the 
colour is intermediate between venous and arterial red. The rest of the mucous 
coat is white, thickened and softened, and interspersed with bright red points 
and patches which are most abundant in the great cul-de-sac, and wholly want- 
ing in that portion of the mucous coat immediately adjacent to the pylorus; the 
lesser cul-de-sac is the seat of several darkish brown patches, and the surface of 
the tissue is here studded with several papillae, and rugose. The mucous coat 
is so much softened as to be nearly pulpy, particularly the portion investing the 
lesser cul-de-sac or antrum of the pylorus. — Dark flakes, the 'grounds' of black 

184 Bibliographical Notices. 

vomit are adherent to all the middle surface between the cardiac and pyloric 
portions of the mucous coat. 

'•''Intestines, viewed externally, are of a darkish colour in various portions of 
of the tract. This colour is seen to be owing-, in some degree, to that of their 
contents. The duodenum is of a dirty grayish white, throughout its entire 
length — its mucous surface is covered with a starchy secretion, and presents 
several small patches of red injection; its minute glands are much developed. 
There exists a similar condition of the ilio-ccecal portion; the patches of Peyer 
are very prominent; — Considerable quantities of a dark gelatinous fluid with 
black flakes swimming in it, are found in diflerent parts of the intestinal tube. 
The black flakes are confined to the superior portion of the tube and appear to 
have descended from the stomach. 

" Urinary Bladder empty, contracted to a point. — Pancreas, Spleen, Kidneys 
present no traces of disease. 

"A few of the dark bottle green concretions are found in the duodenum, where 
they appear to have been carried from the gall bladder by the violent efforts in 
vomiting. 1 regard them as biliary concretions, and not the product of the pre- 
sent disease. They do not resemble at all the matters of black vomit. The in- 
spection of the liver and its appendages renders it clear that the black vomit 
could not have traversed the biliary ducts. — An inch or thereabouts distant from 
the middle of the great curvature of the stomach, the mucous membrane was de- 
ficient about one half of a line in diameter, as if a portion of it had been removed 
with a punch. I was not satisfied whether to regard it as an ulceration or not." 

Art. XXIII. Didionnaire Historique de la Medecine Ancienne et Moderne, ou Pre- 
cis de PHistoire Generale, Technulogique et Litteraire de la Medecine, suivi de la 
Bibliographie Medicale du dix Neuvieme Siecle, et d^un Repertoire Bibliogra- 
phique par ordre de Matieres. Par M. Dezeimeris, Ollivier (d'Angers) et 
Rage-De Lorme, Docteurs en Medecine. Paris, 1828 — 1839. 4 vols. 8vo. 

The object of this work is to present "a concise history of medicine, and of 
each of its branches; a biography of every physician whose writings may still 
be consulted with advantage; the precise title of all his works, and an analysis 
of such as are distinguished by their importance or the singularity of their eon- 
tents; and, finally, a table, or real bibliography, in which is pointed out, under 
the head of each subject, the authors who may be consulted relative to it." 

That an enterprise of such magnitude and one requiring such immense labour 
and extensive and careful researches, has not been executed to the entire fulfil- 
ment of all that could be desired, will, we presume, be anticipated. Much, 
however, has been accomplished; enough indeed to excite our surprise and ad- 
miration. The assistance of M. Dezeimeris's colleagues ceased with the com- 
mencement of the letter E, and the whole of the remaining portion of the work 
has been accomplished by his unaided labours. 

We have often had occasion to consult this work, during the progress of its 
publication, and always with profit, and we congratulate the student of medi- 
cal literature upon its completion. He will find it to afford him essential as- 
sistance in his researches. 

A supplement is promised, which is to comprise the materials collected too 
late for insertion in their proper places; and also extracts from the works which 
are merely indicated by their titles, so as to give what is original to the author 
or useful to be known. 

We regret not to find any hopes held out, that the promised bibliography will 
be furnished. Those who are familiar with the new edition of the Didionnaire 
de Medecine, the first fourteen volumes of which are greatly enriched by the la- 
bours of M. Dezeimeris in this department, know how competent he is for such 
a task; and will be the more anxious that he should include in his supplement 
a bibliography, inasmuch as the intermission of his contributions to the Dic- 
tionary has left a void which it is desirable should be filled. 






1 . Two remarkable cases of complete Msence of the Uterus. — M. Ad. Burggraeve, 
Professor of Anatomy in the University of Ghent, has recorded in a recent num- 
ber of the Annates (Toculis. et de Gynecol, the two following remarkable instances 
of complete absence of the uterus which have come under his own observation. 
In the first case the vulva had no vaginal orifice; the urinary meatus situated 
in the centre of this latter, and the contour of which had been ruptured in the 
act of copulation, readily permitted the introduction of the finger into a sac, the 
parietes of which were soft and membranous and which was easily recognised 
as the bladder. When a catheter was introduced into this sac and the finger 
into the rectum at the same time, it was evident that there existed no organ be- 
tween the intestine and bladder that these were in immediate contact, as is the 
case in the male sex. 

In the second case, the absence of the uterus was verified by post mortem ex- 
amination. The subject of this was a woman 23 years of age who died, in the 
civil hospital of Ghent of Arachnoiditis. This woman was of a robust constitu- 
tion and plethoric habit; her mammae were well developed; pelvis large; sexual 
parts well covered with hair. The vulva presented only a very large meatus, 
the circumference of which was irregular and furnished with numerous myrtiforra 
caruncles. This meatus led immediately into the bladder, and the relations of 
this last with the rectum were the same as in the first case. The ureters, instead 
of descending towards the base of the vesical triangle, opened immediately 
within and on the side of the urinary meatus, so that the bladder was situated 
behind these conduits. The orifices of the ureters were surrounded by sphincters 
which were capable of closing them and thus preventing the immediate flow of 
urine. Beyond these sphincters the ureters were very much dilated and this 
enlargement extended to the kidneys, so that during life these passages had per- 
formed the office of reservoirs. The genital apparatus consisted of two ovaries, 
well formed, situated in a fold of the peritoneum, and containing numerous ova» 
many of which were in a hydatid state. In the same peritoneal fold and imme- 
diately in front of the ovaries were the Fallopian tubes; these last had no canal,, 
and were enveloped in a thick mass of erectile tissue. These tubes were joined 
behind the bladder without communicating one with the other. 

Among the other structural peculiarities observed in this woman was the con- 
genital absence of the velum palati; the isthmus of the fauces was bounded 
above by the free border of the os palati, upon which the pituitary and buccal 
membrane was directly reflected towards the tongue and pharynx to form the 
pillars. The left cerebral hemisphere was smaller than the right. 

The subject of this remarkable case had never menstruated, and had manifest- 
ed very marked venereal appetite. 


186 Progress of the Medical Sciences. 

The preceding- cases with the one related hy Dr. Chew in the original depart- 
ment of this Number, p. 39, constitute a valuable contribution to the history of 
congenital anomalies of the female genital organs. 

2. Experimental Researches on the Functions of the Brain. — According to M. 
NoNAT the lobes of the brain, the corpus callosum, the fornix, the corpora striata, 
the optic layers, the cerebellum, and the crura of the cerebrum, are not possessed 
of general sensibility, as evidenced by touch. In the lobe of the fourth ven- 
tricle, as was shown by MM. Magendie and Desmoulins, resides the faculty of 
the perception of general sensibility. Physiologists are wrong in placing the 
seat of sensibility in the cerebellum, as an animal from which the whole of the 
cerebellum has been removed retains the faculty of seeing, hearing, tasting, 
feeling, and smelling. 

With regard to the influence of the cerebellum over the movements of pro- 
gression or of standing, M. Nonat has arrived at thp following results: 

1. The lobes of the cerebrum direct the movements. Thus, when we wish 
to go from one place to another, it is by the action of the cerebral lobes that we 
are enabled to execute the movements necessary for this purpose. A rabbit 
deprived of the lobes of the brain executes the same movements as before; it is 
only weakened; but it can no longer avoid any obstacle, it cannot find its food; 
in short, it is deprived of that principle which formerly gave to all its move- 
ments a determinate direction. 

2. The corpora striata regulate the movements backwards. 

3. The thalami opHci exercise a considerable influence on the actions neces- 
sary for standing; they furnish in a great measure the principle which supports 
the energy of muscular contraction. 

4. The cerebellum directs the regularity of the forward movements; it appears 
to direct the movements of the lower extremities; and probably has also some 
influence on the equilibrium of the movements. 

5. The circle formed by the cerebellum, its crura, and the transverse fibres of 
the cerebral protuberance regulates the movements of rotation around the axis 
of the animal. 

6. The tubercula quadrigemina are necessary to the regular exercise of motion. 
Their lesion disturbs the harmony of the actions required for progression or for 
standing. This result agrees with that of M. Serres. 

7. The lobe of the fourth ventricle contains a principle which overrules and 
regulates the respiratory movements, vomiting and crying. In this part of the 
encephalon resides a principle, in virtue of which an animal has the conscious- 
ness of tactile, and also of sonorous impressions. — Ed. Med. and Surg, Journ, 
from Gazette Med. de Paris, 19th Oct. 1839. 

3. Prof. ^CYLVUTT^'s Experiments on Digestion. — In our preceding No. (p. 429) 
we gave the results of these interesting experiments and in fulfilment of the 
promise then made we now furnish a narrative of the experiments themselves. 

Exp. 1. — A dog of middling size, which for some time previously had been 
fed upon potatoes, received as much as he could eat of boiled, raw, and roasted 
horseflesh, in pieces of from half to one ounce in weight. He ate, in all, about 
a pound. After three hours he was killed; the digestion had, in the mean time 
made but little progress, and there was only a very small quantity of chyme 
collected at the pylorus. The pieces of boiled meat were every where at the sur- 
face, dissolved into chyme, and were strongly acid, even in the middle, and after 
being washed with water. The raw pieces were less dissolved, but had become 
of a livid hue; and were also less strongly acid at the surface, and in the middle 
not at all so. The roasted pieces were, even at the surface, not perceptibly al- 
tered; they were covered with acid chyme, but upon being washed with water, 
showed no further acidity. The alteration of the boiled and raw pieces increased 
gradually from the cardia to the pylorus; it was imperceptible at the cardia, 
and greatest at the pylorus. There was no difference between the pieces which 
lay at the parietes of the stomach, and those which lay in the centre. The sto- 
mach was firmly contracted about the food, and without any peristaltic motion. 

Anatomy and Physiology, 187 

Exp. 3. — A large dog, that had been fed with potatoes, received in the morn- 
ing at 8 o'clock, from \ to 1^ ounce pieces of boiled, raw and roasted horse- 
flesh; in all about 2| pounds. At three in the afternoon (after seven hours) he 
was killed. Although the digestion had proceeded so far that nearly two ounces 
of chyme were collected at the pylorus, yet the pieces of meat which lay at the 
cardia were still unchanged. The alteration increased gradually towards the 
pylorus, and here the pieces were about half dissolved, none being entirely so. 
The boiled meat was the most dissolved, and was most acid at its centre. The 
raw followed next; and by it the blue paper was reddened in the inside, as well 
as at the surface. The roasted pieces were also acid, even after being washed, 
but blue paper was scarcely altered by the inside. A peristaltic motion was 
present at the pylorus, which from time to time separated itself from the cardia, 
by the strong contraction of its circular fibres. The cardia was firmly contracted 
about the food, and without any perceptible motion. The thermometer stood in 
the stomach and chest at 32° Reaumur, and in the lower parts of the abdomen 
at 31°. 

Exp. 3. — A dog of moderate size was fed with a soup made of potatoes, which 
was mixed with several large pieces, and a little tallow, with which the pota- 
toes were boiled. Six hours after, the soup had disappeared from the stomach; 
the larger pieces were but littie altered, and only somewhat rounded at the edges. 
There was besides a little chyme, mixed with a few fleshy fibres that were prob- 
ably left from the last meal; it was strongly acid, but the pieces of potato were 
but slightly so at their surface, and not at all at their centre. The gall bladder 
was much distended, and contained 2| drachms of bile. Microscopic observations 
showed that the starch globules of the potato soup were still to be found un- 
changed, and in great number, in the intestines. The temperature of the sto- 
mach and chest was 32° Reaumur, of the liver and lower parts of the abdomen 

The stomach, as it contained very little food, was much collapsed, and had a 
peristaltic motion in its whole extent, which, however, was strongest at the py- 
lorus. This motion ceased after half an hour, and when I brought the two poles 
of the galvanic apparatus into contact with the stomach, strong contractions en- 
sued; the separation of the pylorus from the cardia was particularly plain. I 
had laid bare the nervus vagus in the neck, and brought the two poles into con- 
tact with it, but after the spontaneous motion had ceased, no eflTect was produ- 
ced in the stomach. On the other hand, as long as the peristaltic motion lasted 
it was greatly increased by the galvanic excitement of the nervus vagus. 

Exp. 4. — A well fed dog, that would eat no vegetable food, was fed with 1 
ounce of bread, 2 ounces of roasted veal, which was very tender, the same quan- 
tity of raw ham, and 4 ounces of boiled unsalted beef. He was killed nine 
hours after. Three-fourths of the food were dissolved to chyme. The boiled 
beef was entirely digested, and only to be recognised by a few fibres mixed with 
the chyme; the bread was half dissolved, and its remaining part, which was 
mostly crust, was, like the chyme, strongly acid, even in the middle part. One 
fourth of the raw ham had disappeared, and the other part, which was half fat 
did not appear to be at all altered, and was not acid after being washed with 
water. The roasted veal was little changed, and acid only at the surface, and 
not in the inside. The peristaltic motion was observed at the pylorus, but not 
at the fundus; the temperature of the chest and abdomen was 31^^ Reau. 

Exp. 5. — A middling size dog which had fasted the day before, was fed with 
6 oysters, 2 ounces of smoked salmon, 1 of salt herring, and two of boiled pork, 
mutton and unsalted beef. He was killed six hours after. The oysters were 
perfectly dissolved, except the closing muscle of one, and their parts no longer 
perceptible in the chyme. A third of the pork, and three fourths of the mutton 
and beef were dissolved; the acid of the last was the strongest. The pieces of 
salmon were still further divided, but not much digested; the herring was per- 
fectly unchanged, and was acid only at the surface, and not in the inside. 

Exp. 6. — Two half grown cats, that had fasted twelve hours, were fed at the 
same time with similar pieces of raw, boiled, and roasted veal; and further, with 

188 P) Ogress of the Medical Sciences, 

boiled beef and fish, as much as they would eat. One of them was killed three 
hours after. The stomach was without motion, and firmly contracted about the 
food; the digestion had made but little progress, and about two drachms only of 
chyme were collected at the pylorus. The whole mass of the food had formed 
a ball, in which the different parts were not so easily recognised as in the dog, 
for cats tear and masticate their food, while dogs swallow theirs in large pieces. 
At the cardia, the surface of this ball was neutral, and the food was perfectly 
unchanged. In the middle, between the cardia and pylorus, blue litmus paper 
was somewhat reddened, and at the pylorus itself as strongly as usual, by chyme. 
The ball was cut through the middle with a knife, and it was seen that the de- 
gr-ee of acidity was the same at the parietes of the stomach and in the inside of 
the mass. It increased here, also, towards the pylorus. The beef was the most 
digested and the boiled veal more than the raw; the fish and roasted veal, how- 
ever, were still unaltered. 

The second cat was killed after seven hours. The greatest part of the con- 
tents of the stomach were dissolved to chyme, and the stomach itself was three- 
fourths empty; the peristaltic motion, particularly at the pylorus, was also ob- 
served. A few pieces offish were found among the undigested parts, the rest 
was mostly raw and roasted veal. 

The temperature of the abdomen was 31° Reaumur, of the chest and stomach 
31,4° Reaumur. 

Exp. 7. — A full-grown cat was fed with potato soup and a piece of old cheese 
and, after three hours, killed. The cheese was mostly digested, and its small 
remaining part was strongly acid, even in the inside. The potato-soup was 
little altered, and only rendered somewhat more fluid; it very slightly reddened 
with litmus paper. ^ 

Exp, 8. — A dog was fed with boiled, raw, and roasted veal, boiled fowl, fish 
a little boiled unsalted beef, and a piece of old cheese. He was killed four 
hours after. The cheese was entirely dissolved, and only to be recognised by 
the smell of the chyme. The boiled fowl was entirely, the beef and veal for the 
most part, digested, and their remains had fallen into small pieces. The raw 
veal was dissolved at its surface and its colour had become livid; it was acid at 
the surface, and neutral in the middle. The pieces of fish were still further di- 
vided, but it appeared to be merely through the mechanical motion of the stomach, 
for the muscular layers of fish were very loosely connected. The larger pieces, 
after washing, were but slightly acid; whereas the remains of the boiled beef 
were strongly acid even in the middle. 

Exp. 9. — A cat was fed in the morning at nine o'clock, with flower and pota- 
to-soup, and further with a little carrot and boiled beef. It was killed at twelve 
o'clock. A piece of meat, which the animal had swallowed last, and which 
was found at the cardia in the midst of the soup, was still unchanged. The rest 
at the pylorus was quite dissolved; the soup was become somewhat more fluid 
and it was slightly acid; the carrot and a few pieces of potato were unaltered, 
and without acidity in the inside. 

Remark. — I have often observed in dogs, that the order in which the different 
sorts of food are swallowed considerably alters the relative digestibility; for I 
have several times seen indigestible matter which was swallowed first, and there- 
fare came first to the pylorus, digested before other food which was more easily 
digestible, but which being swallowed later, came later to the pylorus. 

Exp. 10. — A dog of middle size which had been fed upon flour and potato soup, 
and afterwards allowed to fast 24 hours, was fed at nine o'clock in the morning 
with one or one and a half ounces of old cheese; two, the same quantity of Dutch 
cheese; three, the meat from the claws and tails of two large crabs; four, three 
ounces of roasted pork; five, an ounce of the fat of a smoked goose; and six, with 
four ounces of boiled unsalted beef. At half-past one he was killed; nearly 
one-half of the whole mass was changed into chyle; a pretty strong peristaltic 
motion was observed at the pylorus. I observed also an undulating motion 
along the course of the large curvature; the small curvature, however was per- 
fectly motionless. 

Anatomy and Physiology. 189 

1. The boiled beef, of which a few small pieces were still visible, was dis- 
solved. 2. The old cheese was entirely, and the Dutch cheese mostly, dissol- 
ved; its remaining- part was chiefly rind, the surface and inside of which were 
strongly acid, even after washing with water. 3. The roasted pork was net 
much altered at the surface, although the inside was somewhat acid. The crab's 
flesh and goose fat were found in the chyme perfectly unchanged; the litmus 
paper, however, was slightly reddened at the surface of the crabs'-flesh after it 
■ was washed, but not in the inside. The fat, on the contrary, showed no acidity 
after being washed, even at the surface. 

Exp. 11. — A distinguished individual of this city desired to know if it was 
true, as is generally believed, that oysters are more easily and quickly digest- 
ed, if a little cheese be eaten at the same time. I was aware how difficult it 
would be to institute experiments upon this question upon dogs, for these ani- 
mals, even after having fasted 24 hours, will never voluntarily devour oysters, so 
that they must always be given to them by force. However, I learnt, from Exp. 5, 
that when dogs have once swallowed oysters, they digest them very easily, and 
do not vomit them, as one would expect, after so much aversion. I therefore 
procured two dogs of the same size, and apparently of the same age. Both were 
allowed to fast 16 hours, so that in every respect they were nearly similar, ex- 
cept in colour, for the one was black and the other white. They were fed, or 
rather the food was forced down their throats, at eight o'clock in the morning. 
The white dog received eight oysters, and a small piece of bread; the black, 
eight oysters, apiece of bread, and about H oz. of cheese. At eleven o'clock 
or three hours after, both dogs were killed. In the, white one, which had receiv- 
ed oysters and bread only, I found 8^ drachms of chyme of the usual quality 
together with four pieces of undigested oyster, which after washing with water 
weighed 4J drachms; the whole of the contents of the stomach, therefore, weighed 
13 drachms. In the other, which had eaten cheese with the oysters, there were 
13.^ drachms of very viscid chyme, and three small cartilaginous pieces of undi- 
gested oyster, which weighed 1 drachm 2 scruples; the weight, therefore, of the 
contents of the stomach of this dog were 14 drachms \\ scruple. The dog which 
had received th^ cheese had accordingly digested in the same time, and with the 
same number of oysters, 2 drachms 50 grains more than the one that had been 
fed with oysters and bread only. The chyme, also, in the stomach of the former, 
was much more acid than in that of the latter; upon this point my experiments 
upon the degrees of acidiiy in the alimentary canal may be consulted. 

I now made some microscopic observations upon the manner of dissolution of 
the fleshy fibres in the stomach and intestines of the dog. 

Exp. 12. — Raw meat obtains at the beginning of digestion a rough, raggedy 
appearance, which is particularly distinct under water. This raggedness is soon 
dissolved from the larger pieces, and may afterwards be found in the chyme. If 
a piece of the same be examined under the microscope, it is found that the mus- 
cular fibres do not separate from one another lengthwise, but remain together 
in large pieces. In fresh meat it may be seen, that the muscular fibres are ar- 
ticulated, and marked with fine transverse lines upon the spaces between the 
articulations. They are firmly connected at the sides, and are with difficulty 
separated from one another lengthwise. This connection remains during 
digestion, and the gradual solution takes place so, that the joints separate them- 
selves into pieces which become gradually smaller, and in this condition fall 
apart lengthwise. At last, these pieces dissolve into very small globular 

Boiled flesh is easily separated into fibres lengthwise; the articulations of the 
fibres and also the fine transverse lines, may be seen here, as well as in raw 
flesh: it is, however, more condensed, and the fibres are thinner, than in the raw 
condition, as may be seen in the fibres of boiled veal, when compared with raw 
veal. The first change which takes place in the boiled flesh of the mammalia in 
the stomach of the dog is, that the muscular fibres separate themselves from one 
another lengthwise. Roasted meat is not so easily separated into single fibres, and 
this, together with their greater hardness appears to be the reason why it is harder 

190 Progress of the Medical Sciences, 

to digest. In proportion as the fibres separate themselves in this manner length- 
wise, they also fall into pieces transversely, and assume the appearance of hav- 
ing been cut with a sharp instrument. The pieces of muscle are also at first 
so sharped edged, and for the most part remain so during their continuance in the 
stomach. In the duodenum, however, their edges become rounded, and the pieces 
appear to dissolve gradually, like a crystal in water, till at last a very small part 
only is left. The chyme in which they are found has a fine granular ap- 

The solution of boiled fish in the stomach of the cat takes place somewhat 
diflferently. The muscular fibres offish are much larger than those of the mam- 
malia and birds; they have also fewer articulations, and are more angular. They 
are strongly marked with longitudinal lines. These longitudinal lines are 
sometimes also to be seen in the muscular fibres of the mammalia; and, on the 
other hand, the transverse may be seen in the fibres offish, though both cases hap- 
pen but seldom. In the stomach of the cat, the fibres of fish separate themselves 
lengthwise from one another, and first appear with broken edges. The further 
solution, however, is quite peculiar. At first, large transverse fissures, which 
often go as tar as the middle, arise at the sides, at which the fibres gradually 
fall into smaller pieces. The fibres now begin to dissolve at the end, and in 
the direction of the longitudinal lines, into sets of large globules, which gradu- 
ally separate from one another, and in this condition may be afterwards found in 
the chyme. 

Exp. 13. — After I had obtained from the manner of the solution of the mam- 
malia fibres, a sign of the degree of perfection of the digestion, I wished to 
know whether the disturbance of the digestion, which I had experienced in my- 
self from drinking coffee after meals, could be explained by experiments upon 
dogs. I therefore gave a dog a little coffee, with milk, directly after he had 
eaten several large pieces of meat. He was killed six hours after, and I found 
that the digestion had been delayed longer than usual; but in the manner of the 
solution of the muscular fibres, I perceived no remarkable difference. 1 now 
conjectured that the coffee was absorbed from the stomach, and that afterwards 
the digestion proceeded in its regular course. I therefore fed a dog with meat 
chopped very small, and gave him a little coffee, half an hour after. I killed 
him four hours after, and found that the greater part of the meat had gone over 
into the intestines, but little or not at all altered, and also that the unchanged 
fibres of meat, that could therefore have been litile digested, were to be seen as far 
as the ccecum. In these the microscope could detect but few traces of solution 
although in general the fleshy fibres disappear entirely below the ilium. — Lancet^ 
Nov. 16, 1829. 


4. On Diuresis as a Revulsive action in Diseases of Infants. — Dr. Simon pre- 
faces his remarks by alluding to the frequent inactivity, and sometimes the 
almost complete suspension, of the functions of the bowels and kidneys, while 
the system of the child is suffering severely from dentition. Whenever the in- 
testinal or urinary excretion is much diminished, the febrile irritation of the 
system, it is well known, is invariably greater than usual; and if this state of 
things be permitted to continue without relief, there is much risk of alarming 
cerebral symptoms quickly making their appearance. The practitioner will 
therefore do well to pay particular and uniform attention to the condition of the 
bowels and kidneys in all diseases of infancy and childhood. The simple ques- 
tion as to the quantity and colour of the urine — and by the bye we can much 
better trust the report of nurses about the state of the urine than we can about 
that of the alvine evacuations — will often enable us at once to form a correct 
opinion as to the general or constitutional health of our patient. As long as 
the kidneys act freely, there is little or no risk in the symptoms of mere denti- 

n ^ 


Pathological Anatomy and General Pathology. 191 

tion, however severe and distressing these may be. The same remark is, we 
believe, strictly applicable to the procrnosis of most cerebral affections in children. 
When the urinary secretion is scanty and deep-coloured, the circulation seems 
to be both oppressed and excited; and the rapid, on some occasions almost in- 
stantaneous, mitigation of the alarming symptoms after a copious discharge of 
water is well known to all experienced practitioners. To promote this critical 
diuresis, a purgative composed of senna and salts, and then frequently repeated 
doses of nitre,* are the simplest and most efficient means that can be resorted to. 

The chief danger of dentition is referrible to the vascular excitement of the 
brain. Nor is this wonderful; when jve consider that for several successive 
months there is a continued, and often very severe, irritation in its immediate 
neighbourhood. The pain attendant upon the cutting of merely one tooth, in 
our adult years, may teach us to form some idea of the suffering of an infant 
during the period of its first dentition. 

Now it is a common observation that almost all headaches are most promptly 
relieved by whatever stimulates the kidneys to throw off a quantity of urine. 
When this takes place the system feels at once relieved of a load or oppression 
which seemed to clog all its energies, and the mind as well as the body becomes 
more light and vivacious. We are thus led by the experience of our own 
feelings to anticipate the benefits which must attend the stimulation of the kid- 
neys in the various affections of children arising from teething. 

On the whole, we do not think that there is a more important sign to be at- 
tended to in the management of children, during the first two years of their life, 
than that afforded by the state of the urinary secretion. If nurses and mothers 
were better aware of this simple, but most valuable suggestion, the life of many 
an infant might be saved; for disease would often be detected in its earliest 
stage, and then might certainly be arrested by the administration of appropriate 
means. With regard to medical men, we strongly counsel them to make it an 
invariable rule in their practice to inquire into the state of the urine. As we 
have already hinted, we can more generally depend upon the reports of mothers 
and nurses as to the appearances and condition of the urine than of the alvine 
evacuations, in those cases where we cannot examine the excretions for our- 

Nothing will more contribute to relieve the system of the feverish irritation, 
under which the system of a child suffers during dentition, than a copious diu- 
resis. We should bear in mind, too, that independently of the excitement arising 
from this cause, there is naturally and necessarily a tendency to over action of 
the blood vessels in the head during the first year or two of life. The brain, it 
is well known, is larger then in proportion to other parts of the body than in 
after years; all the senses are, probably, more acute, the mind as well as the 
body is rapidly growing, and perhaps scarcely a day passes over without there 
being made some addition or another to the store of infantine perceptions and 
ideas. We cannot wonder then that the simultaneous developernent of so many 
organs and new faculties should have a powerful influence on the physiological 
and pathological phenomena which characterize this period of life. To refer all 
to the excitement arising from the evolution of the teeth, is to take a very partial, 
and therefore an erroneous, view of this important question. A valuable thera- 
peutic principle is suggested by these considerations; and it is this: that in the 
treatment of many diseases of infancy we have rather to regularise than directly 
to check or overcome; and therefore that we should most attentively examine 
the condition of all the functions of the body, in order that we may discover the 
direction or sense, so to speak, in which nature's efforts are working, and be 
enabled to assist her in these efforts. 

* Some practitioners are in the habit of adding minute doses of digitalis to the diu- 
retic mixture; and seemingly with good effects. The following formula will be found 
to answer well. R. Potassse nitratis 9j; Aquse m. viridis §ijss; Syrupi croci jij. — . 
Vini antimonialis ^iss; Tinct. digitalis lltxvj. M. A tablespoonful to be given every 
two or three hours. 

4 ii 

192 Progress of the Medical Sciences, 

Before closing these remarks, we may very briefly allude to the notable effects 
which diuretic medicines sometimes exert on the progress of hooping-cough. 
The administration of nitred drinks and of minute doses of digitalis* seems often 
to promote the crisis of the disorder in its earlier stages; and in its more ad- 
vanced and chronic form, the use of tincture of cantharides has been recommend- 
ed by Dr. Watts and others, as one of the most efficient antidotes. f The ex- 
citement of the urinary viscera produces a powerful revulsion on the neurosthenic 
condition of the gastro-pulmonary apparatus, and thus seems to act as a deriva- 
tive of the morbid action. 

In fine, the kidneys become, in numerous cases of disease, the seat of an 
active eliminatory process, of which the skilful physician will avail himself in 
the treatment of dentition and of various other affections to which children are 
especially liable during the first two years of life. Medico- Chirurgical Review, 
from Bulletin Gen. de Therapeutique, May 1839. 

5. Remarkable Tendency to Hemorrhage in a Family. By Dr. Du Bois, of 
Neuchatel. — This affection, which consists of an extreme fluidity of the blood, 
or a weakness of the capillary vessels, which are ruptured by the slighest vio- 
lence, and have but little contractile power, is not uncommon in the west of 
Germany, and in the Rhenish provinces. It is hereditary in a striking degree; 
though only males are affected by it, to whom it is frequently transmitted by 
their mother, who is free from its influence. In some families scarcely a single 
male arrives at maturity, from this cause; and the person thus diseased bears 
the significant name of Bluter or Bleeder. 

A robust gardener of Neuchatel married a stout, healthy woman from Nassau, 
in whose family, according to her account, no Bluter had been kno\vn. By her 
he had a family, consisting of five boys, and one girl who never exhibited any 
symptoms of this complaint, and died in convulsions when three years of age. 
Of the five boys, one died of convulsions on the day of his birth; three died of 
hemorrhage; and the last, now seven years old, will probably soon follow his 
brothers, from the same cause. The symptoms exhibited the following course 
in all. A fortnight after birth, which was natural, ecchymoses began to appear 
in different parts of their bodies, spontaneously, or from the slighest pressure, 
and slowly disappeared, leaving a yellow tint behind them. About the end of 
the first year, but especially after the third, they were seized with violent epis- 
taxis. The slightest puncture caused a great loss of blood; coughing produced 
haemoptysis, and diarrhoea bloody stools in clots. The fourth bit his tongue 
at play, and died in a few days from the hemorrhage, which it was impossible to 
restrain. All were subject to frequent attacks of pain and swelling, with ecchy- 
mosis of the wrist, ankles, and knee-joints, attended with fever; the complaint 
usually lasted about a fortnight, and then disappeared with the subsidence of 
the swelling and removal of the ecchymosis. On one occasion, two leeches 
were incautiously applied to the knee of the eldest, the bites of which continued 
to bleed for three days, and were only stopped by the twisted suture. Except 
varicella, which the survivor has had, none of the others were attacked by in- 
fantile diseases, though prevalent in the neighbourhood. Dentition took place 
pretty early, and in a healthy manner. A tendency to diarrhoea, that was fol- 
lowed by bloody evacuations, was the sole affection of the organs of digestion 
to which they were liable. Their complexions were fair, with clear blue or 
brown eyes, and a skin remarkably fine and. white. Their gums were always 
firm, and they never had ulcerations of the mouth or skin. Their intelligence 
was quite conformable to their age. Their urine was usually clear and limpid, 
but they had great tendency to perspire. The eldest died of epistaxis, at the 

* Dr. Simon recommends the external use of tincture of digitalis rubbed, as a lini- 
ment, on the abdomen. ''^ 

+ A favourite formula of some physicians in certain chronic cases of hooping-cough 
is the following: — R. Tinct. cinchonae,§3iij; Tinct. lyttse. ^j; Tinct. camphofJB comp. 
3ij; Mist. Camphor, ^ijss; M. Capiat coch. j. magnum ter in dies. 

Pathological Anatomy and General Pathology. 193 

ag-e of twelve; the second died at the a^e of eight, of hemorrhag-e from all the 
mucous surfaces; and the third, as before mentioned, from biting his tongue, 
when twenty months old. The blood from these hemorrhages was very fluid, 
of the ordinary colour, and coagulated like other blood. 

The surviving boy has undergone the same complaints as his brothers; he is 
seven years old, of ordinary stature, delicate, rather thin, light complexioned, 
with light brown eyes, that are quick and intelligent; his skin is extremely 
white and transparent, with very little appearance of veins, that are very small, 
even on his hands and forearms; his face is exceedingly pale, but his nose, like 
that of his brothers, is of a bright red. His pulse is eight or ten beats quicker 
than in boys of his age, his breathing is normal, his gums are firm and sound, 
and the ends of his fingers exhibit no peculiarity. Respiration is puerile; there 
is slight hypertrophy, and the beats of the heart are very strong and smart 
(secchi), a circumstance also observed by his mother in the other children. The 
sounds of the heart are natural; and none of the children were subject to pal- 
pitation nor dyspnoja. No enlargement of the liver or spleen can be detected. — 
Brit, and For. Med. Rev. from Omodei Jinnali. Ixxxv. 1838. 

6 . Ulceration of the Throat extending to the Lingual Artery ^ death hy Hemorrhage, 
Dr. Duncan presented to the pathological society of Dublin the recent parts' in 
this case. The patient, a young man, had been under treatment in the Ade- 
laide Hospital, for ulcerated sore throat, for some time, when he was suddenly 
attacked with hemorrhage from the throat, which returned twice in the course of 
a fortnight. He had left the hospital, but was readmitted, and on the following 
day the bleeding returned with greater violence, and he was much exhausted. — 
The ulceration was found to have attacked the right lingual artery, which pre- 
sented a perforation capable of admitting a large sized probe. The os hyoides 
v/as found to be carious. Dr. Duncan alluded to cases of the same kind which 
occurred under the care of the late Dr. M'Dowell, in one of which the external 
carotid had been tied with perfect success. — Dublin Journal of Medical Science, 

7. Softening of the anterior column of the Spinal Cord, in its cervical portion. — 
Dr. Power begged to draw the attention of the society to a well marked and 
recent specimen of acute softening of the anterior column of the spinal cord. — • 
The patient, a woman aetat. 50, was suddenly attacked with paralysis of motion 
in the upper and lower extremities. The bladder and rectum were unaffected; 
a slight power of motion remained in the limbs. There was no loss of sensation; 
no fever, headache, or disturbance of intellect. Sensation in the paralysed por- 
tions was perfect. Soon afterwards she was attacked with dyspnoea, and her 
breathing became diaphragmatic: ultimately the diaphragm became paralysed, 
and death took place with great dyspnoea. The spinal column was opened on 
the following day, and the cervical portion of the medulla spinalis was found 
softened to a great degree. — Ibid. 

8 Fragilitas Ossium. — Mr. Adams exhibited to the Dublin Pathological Society, 
the recently removed parts in this case, the subject of which was a man, setat. 41, 
who had been an inmate of the House of Industry for five years, having been com- 
- pelled to abandon his employment, in consequence of severe pains in the legs 
and thighs; he was bed-ridden for two years before his death; upon one occasion 
the left femur broke across in the centre from slight exertion; while raising him- 
self in bed, the olecranon was fractured, and afterwards he got a fracture through 
the neck and trochanter of the right femur; during the latter part of his existence 
he suffered great agony, and died worn out by diarrhoea. Upon examination the 
muscles were found wasted, and containing between their fibres a soft unhealthy 
adeps; the bones were soft, and contained a large quantity of oily matter; the left 
femur was broken in its lower third and in its centre; the greater trochanter was 
separated from the shaft, and the cervix broken within the capsule, and absorbed 
completely; the two fractures which occupied the shaft of the bone had under- 
gone osseous union, but with great overlapping and consequent shortening of the 
No. LI.— May, 1840. 17 

194 * Progress of the Medical Sciences, 

limb; the fracture of the right femur ran through the trochanter, it was commi- 
nuted, and extended within the capsule; an immense quantity of osseous matter 
extremely porous and vascular in its texture, was thrown out on the entire of the 
left femur, and bony spiculae projected from it among the muscles; a large plate 
of bone was found in the glutaeus medius. — Ibid. July, 1839. 

9. GuYON, on Living Worms under the conjunctiva of the Negro. — Blot of Marti- 
nique has, like Bajon of Cayenne, and Mongin of St. Domingo, seen two worms 
in active motion under the conjunctiva, which he removed by incision. One of 
these, which was sent to M. Blainville, was thread-shaped, thirty eight millime- 
tres long, with a black protuberance adapted for suction. 

Bajon remarked (1768) a serpentine motion of a worm in the eye of a negress 
which, without giving pain, caused constant epiphora. When an incision was 
made, the worm went to another part, and was obliged to be secured with a small 
forceps. In a second case (1771) the conjunctiva was more inflamed, the patient 
refused to submit to operation. In Blot's case (1828) the worm lay on the out- 
side of the eye, and sometimes turned around a portion of the corner, causing 
stinging pains and nervous symptoms arising probably from fear. The patient, 
aa African negress, was unable to tell where she came from, or whether her fel- 
low-country people were subject to this disease. A surgeon at Mompox (New 
Granada) oflTered to extract this worm, but his services were refused. The worms 
found by M. Guyon were not of the species termed Filaria Medinensis, which 
are found in abundance amongst Africans, and could not be secured by the for- 
ceps. — Dublin Journal^ from Zeitschriftfur die gesammte Medicin, Feb. 1839. 

In the London Med. Gazette for Aug. 1833, there is given the case of a little 
girl, six years old, under whose conjunctiva, and resting on the sclerotica, there 
was found a cysticercus cellulosa perfect in all its parts. 

10. Chronic Endocartitis with permament Patency of the aortic valves. — Dr. C or- 
rigan laid on the table of the Dublin Fathologieal Society the heart of a young 
man, who was attacked with acute rheum.atism in 1822; he recovered from this 
under active treatment, but did not regain his usual state of health; he became 
subject to palpitations, for the relief of which strict antiphlogistic treatment was 
enjoined and persisted in, until the extreme debility of the patient would no 
longer allow of it; an opposite plan of treatment was then recommended, and 
under the use of stimulants and nufritious diet he improved rapidly. Being a 
member of the medical profession, he was elected in 1826 as superintendant of 
a dispensary in the country, and for many years was able to discharge his duties 
with great activity. In 1835, he applied to Dr. Corrigan for a certificate to 
enable him to effect an insurance on his life, and stated that his heatlh was per- 
fectly restored. Dr. Corrigan declined giving the certificate, having detected 
a bruit de soufflet under the sternum, accompanied by pulsation of the veins of 
the neck and fremissement of the carotids. He continued to enjoy tolerably 
good health until a few months ago, when he was attacked with symptoms of 
gastric and hepatic derangement, followed by debility and complete prostration; 
the action of the heart became so feeble, as to be scarcely perceptible, when 
he raised himself into the erect posture. He died in syncope. 

Upon opening the chest some adhesions, seemingly of recent formation, were 
found between the heart and pericardium; a vast number of warty excrescences 
existed upon the surface of the aortic valves, which were thickened, indurated, 
and puckered, so as to be incapable of closing the opening of the artery; the left 
auriculo-ventricular opening was slightly contracted; the heart had acquired an 
enormous size, owing to the inefficiency of the aortic valves to discharge their 

Dr. Corrigan remarked that this case, taken in connection with others of a 
similar nature, led to the conclusion, that in permanent patency of the aortic 
valves hypertrophy of the heart is a provision of nature, to enable the organ to 
propel its contents, and support the additional weight thrown upon the ventricle, 
in consequence of the inadequacy of the valves to the performance of their func- 

Materia Medica and General Therapeutics. 195 

tions: it was also obvious, that in such instances antiphlogistic treatment was 
injurious. For fourteen years precedinor this patient's death, the bruit de soufflet 
was never absent. — Dublin Journ. of Med. Sci. 


11. On the employment of a new Vegetable 3Ionesta, in Medicine. By Dr. G. 
J. Martin St. Ange. — A vegetable substance called mnnesia^ has lately been 
imported from South America, in the form of hard thick cakes, weighing- about 
five hundred grammes (9215 grains.) These loaves, which are flattened, and 
have paper of a yellow colour adhering to them, are composed of the extract, 
prepared in the country, from the bark of a tree whose botanical name is not 
known. M. Bernard Derosne, the drugcrist who introduced it, informs me that 
some travellers call the monesiabark g-oAar«m, and others buranhem. But what 
is of more importance is, that the naturalists who have examined it think that 
the tree which furnishes it is a chrysophyllum. 

The extract is of a deep brown, and very friable; when broken it looks like 
a well-roasted cacao nut. It is entirely soluble in water, and its taste, which is 
at first sugary like liquorice, soon becomes astringent, and leaves behind a well- 
marked and lasting acid taste, which is particularly felt in the tonsils. 

The bark of the monesia is smooth and grayish, like that of the plane tree, 
with this diflference, however, that it is much thicker, that its fracture is imbri- 
cated, and that its sweet taste forms a strong contrast with the bitterness of the 
thin laminae which are detached from the plane. 

The chemical analysis &f the bark of the monesia, and of the imported extract, 
according to MM, Bernard Derosne and 0'Henry,has demonstrated the presence 
of the following soluble principles: — 1. Chlorophylle; 2. vegetable wax; 3. a 
fatty and crystallizable matter; 4. glycyrrhizine; 5. an acrid and somewhat 
bitter substance; 6. a little tannin; 7. an unexamined organic acid; 8. a red 
colouring matter, resembling that of cinchona; 9. phosphates of lime, witli 
organic acids. 

The pharmaceutical preparations which have been made with this substance 
are — 1. an aqueous extract; 2. syrup, containing thirty centigrammes (5^ 
grains) in the ounce; 3. a hydro-alcoholic tincture, containg two grammes (37 
grains) per ounce; 4. chocolate, containing thirty centigrammes (5 V grains) in 
each cake weighing three decagrammes (7 drachms, 49 grains;) 5. an ointment, 
containing an eighth part of its weight of extract; 6. monesine, being the acrid 
substance mentioned in the analysis. 

The extract contains about eight per cent, of glycyrrhizine, and twenty per 
cent, of acrid matter. 

The following accounts of monesia are already in existence: — 1. A manu- 
script memoir, which is in the hands of the commissioners appointed by the 
Academy of Medicine. 2. A synoptical table, giving the analysis, some phar- 
maceutical preparations, and the medicinal preparations of monesia. 3. A 
very minute summary of these two papers, entitled, "Account of Monesia." 
4. An article inserted in the Bulletin Therapeutique. 

I will now give a succinct account of the facts which have been published, 
before mentioning the results which I have obtained myself. 

_ The medical cases in the synoptic table have been drawn up by several physi- 
cians in Paris; they give the nature of the disease, the sex, the profession, the 
age, and the constitution of the patient; the mode of treatment, the duration of 
the disease, the termination; and lastly, the remarks suggested by each method 
of treatment. 

M. Alquie, professor of internal pathology at the Val-de-Grace, found — 

1. That of forty-two soldiers attacked with diarrhoea of different degrees of 
severity, thirty-six were cured in twelve days; twenty-four by the extract of 
monesia given in pills, in the dose of from eighty centigrammes to a gramme 

196 Progress of the Medical Sciences. 

(14| to 18^ grains) a day; and twelve by the tincture, administered as a clyster, 
in the dose of eight grammes (147 2- grains) in two hundred and fifty grammes 
(4607 o grains) of bran water. 

2. That in two cases of menorrhagia, the extract and the tincture of monesia 
given internally soon calmed the pain, and stopped the uterine discharge. 
^ 3. That in four women attacked with profuse leueorrhcEa, the extract of mone- 
sia given internally, and the diluted tincture injected into the vagina, were bene- 

4. That in two cases of haemoptysis, where bleeding, ligature of .the limbs, 
and ordinary astringents, had been employed without advantage, the extract of 
monesia succeeded completely; and that several chronic cases of bronchorrhcea 
were benefitted by the syrup of monesia, which was sometimes combined with 

M. Baron cites— 1. A very remarkable case of chronic iaflammation of the 
vagina, of a syphilitic kind. No advantage had attended the previous use of 
baths, local bleedings, emollient and astringent injections, the nitrate of silver; 
a year later the diluted supernitrate of mercury, sulphureous baths, leeches, and 
the repeated application of blisters and sinapisms, were equally useless. In 
spite of these remedies the discharge from the vagina became more abundant. 
Injections were then used containing thirty grammes (552 grains and 9-lOths) 
of the extract of monesia in a hundred and fifty grammes (27642 grains) of 
water. In eight days the discharge was much diminished, and in three weeks 
the patient was cured. The discharge returned in a month, but again yielded 
to the same injection. 

2. A case of leucorrhcea. The discharge was copious, of a yellowish white 
colour, and accompanied with pains in the gYoins and lumbar regions; baths, 
leeches, and injection of mallow water and laudanum, had produced no benefit. 
Injections of monesia, in the proportion of thirty grammes (552 grains and 
9-lOths) to a hundred grammes (3317| grains) of water, were employed once 
a day, and the patient was cured in a fortnight. 

3. Several cases of diarrhoea, which resisted the means generally used, were 
cured by the extract of monesia given internally, and clysters containing the 
tincture, in different proportions. 

M. Buchez has employed the extract of monesia, and has remarked, that it 
delayed the progress of caries in the teeth, and that, when combined with opium, 
it often soothed the pain more effectually than the opium alone. He recom- 
mends the employment of the tincture to keep the gums in a healthy state. 

M. Daynac speaks of the good effects he has obtained from the preparations 
of monesia (the syrup, lozenges, and paste) in several cases of the chronic 
catarrh of the old, in dyspeptic persons, and in the third stage of phthisis. He 
also cites remarkable cases of scrofulous engorgement, much benefitted by the 
use of the tincture of monesia, in the dose of eight grammes (147 1-2 grains) 
daily, continued for a greater or less time. Lastly, the extract of monesia 
in pills, in the dose of from sixty to ninety centigrammes (11 to 16 1-2 grains) 
has been very serviceable in uterine discharges. 

M. Laurand speaks of a well-marked case of scurvy which he cured with 
monesia. The patient had had frequent epistaxis, which had several times 
required the nostrils to be plugged. He was made to inspire acidulated water 
by the nostrils, containing thirty grammes (552 grains and 9-lOths) of the tinc- 
ture to a pound of water. This stopped the hemorrhage; but when the same 
thing had been done with acidulated water not containing monesia, it had not 
succeeded. The patient also took from a gramme to a gramme and a half (18 1-2 
to 27| gains) internally every day. The same physician has ascertained the 
efficacy of monesia in a great variety of circumstances, particularly in gangre- 
nous eschars on the sacrum. 

M. Manec has employed the different preparations of monesia with success: 
— I. In a man who, for six years, had had a large serpiginous ulcer in the bend 
of the groin, which had resisted every kind of treatment, and which rapidly 
improved under the use of monesia ointment. 

Materia Medica and General Tlierapeutics. 197 

2. In a great number of aged women labouring under diarrhoea, and in per- 
sons affected with chronic bronchitis. 

M. Monod has furnished some very interesting cases; some of ulcers of the 
nose, and others of affections of the intestinal canal. The ulcers were dressed 
with the powdered extract, and cured in a few days. In the other cases the 
extract given in pills to the amount of from si^ty to a hundred and twenty cen- 
tigrammes (11 to 22 grains) daily, was perfectly successful. 

M. Payen, who has employed monesia in a great number of cases, has seen 
a patient in whom leucorrhcea was considerably increased by this medicine, 
administered two different times; the monesia was then tried as an injection, 
and the discharge, which had hitherto resisted every remedy, disappeared, and 
did not return. The same practitioner cites two cases of uterine hemorrhage, 
where the patients were obliged to keep their bed for a fortnight at each men- 
strual period, and in which the monesia brought back the discharge to its healthy 
standard. Lastly, M. Payen has succeeded in cicatrizing an ulcer in the lower 
jaw, which, for ten months, had resisted every kind of treatment, both internal 
and external; and in healing ulcerated chilblains, by means of the ointment and 
the powdered extract of monesia. 

Thus we see that monesia has been employed both externally and internally. 
It has been frequently administered during the chronic stage of bronchitis, 
usually alone, but sometimes combined with opium, and in the greatest number 
of cases it has seemed to act advantageously upon the disease, the expectora- 
tion and respiration being rendered more easy. 

In many cases where pulmonary hemorrhage was prolonged, having resisted 
various and generally efficacious remedies, the extract of monesia has stopped 
the spitting of blood. 

In weakness of the stomach monesia has a favourable influence on digestion, 
and secondarily on nutriiion. This medicine has also been very beneficial in 
chronic enteritis; it has chiefly succeeded against diarrhoea, from whatever cause 
it arose. 

The efficacy of monesia taken internally has been less marked in leucorrhcea 
than in diarrhoea, yet it has been useful in the majority of patients who have 
taken it; but injections have been more advantageous. 

In every case of uterine hemorrhage where monesia has been given, it has 
succeeded in moderating and suppressing the discharge more readily than the 
other remedies which had been previously used. 

Monesia has also been of great advantage in scorbutic and scrofulous affec- 
tions, and has always benefitted ulcers of a bad character, whether the oint- 
ment, or the pure extract powdered, or the acrid substance contained in it, has 
been employed. 

Such is the compendium of the cases hitherto published, with the exception 
of four by M. Forget, which are the basis of the article that he has published 
in the Bulletin Therapeutique^ and which, as he says himself, neither tell for 
nor against monesia. 

We may say, therefore, generally, that monesia shows its maximum of power 
in diseases of the digestive organs, in hemoptysis, uterine hemorrhage, and 
ulcers of the skin, or of the mucous membranes, at their origin. A remarkable 
point in this remedy is, that although it is gifted with energetic powers, and 
has acted upon the tonsils or upon ulcerations as an active stimulant, it has 
never irritated the stomach as tonics, properly called, often do. In order to 
form a due estimate of its relative activity, we must not forget that it has always- 
been employed after the exhibition of other remedies. 

I now come to my own cases, the general results of which may be stated as 
follows: — 

Monesia, when exhibited internally, in the dose of from 75 to 125 centi- 
grammes (14 to 23 grains) of the extract daily, for eight or ten days, whether 
in the form of pill, tincture, or syrup, has an immediate effect upon the diges- 
tive passages, and quickens the action of the stomach in a very remarkable 
manner. If the dose of the remedy is pushed to four grammes (74 grains) of 


198 Progress of the Medical Sciences, 

the extract daily, for fifteen or twenty days, the appetite increases, but the 
patients sometimes experience a feeling of heat in the epigastrium: tenesmus 
and obstinate constipation may also come on; hence its action upon the diges- 
tive tube should be moderated by diminishing the dose according to the effect 
produced, and administering emollient or laxative clysters, as may be required. 
Monesia ointment may be employed externally, upon sores, in every case, but 
with more or less success, according to circumstances: thus I have seen it suc- 
ceed in large and excessively painful ulcers, arising from the action of blisters, 
in sores produced by burns, in varicose ulcers and old wounds; in a word, when- 
ever the sore is painful, and depends on a merely local affection. When this 
is not the case, and the ulcer is kept up by syphilis, scrofula, scurvy, or cancer, 
it is impossible to effect a permanent cure by merely applying the monesia 
ointment, washing the sores with the tincture, or sprinkling them with the 
extract or acrid principle contained in it. Yet, by employing these different 
preparations in a proper manner, we may hope to modify the sores, and even 
to cure them for a time. Generally speaking, the ointment, when applied to a 
sore, calms the local pain; the tincture thus used, produces a sensation of 
heat, which ceases immediately; the powdered extract more or less excites the 
sore, and the acrid principle in powder, when well prepared, has a special acti- 
vity greater than caustic: hence it is a powerful remedy against fungous or 
atonic ulcers of a bad appearance; but as soon as these sores become painful, 
and especially when they are covered with a whitish pellicle, the use of the 
acrid principle should be discontinued; for it is usually this pellicle which, by 
preserving the surface of the sore from contact with the air, and perhaps by 
becoming partly organized, produces cicatrization. 

i have said expressly, that it is impossible to obtain a lasting cure of syphi- 
litic or cancerous sores by the mere external use of this remedy; in such 
cases, therefore, we must have recourse to a specific treatment capable of acting 
on the system. I have found that in order to effect the cure of scrofulous 
ulcers, the monesia must be employed internally, for five-and-twenty or forty 
days, and even longer, according to the case; and this in large doses, such as 
four or five grammes (74 or 92 grains) of the extract daily, in the forrn of pill, 
tincture, or syrup. In this way I have succeeded in curing or benefitting seve- 
ral scrofulous patients. Here follow two remarkable examples. — 

Case I. — A young man of 17, a printer, born of very healthy parents, came 
to see me in February, 1839, to have the little finger of his left hand ampu- 
tated. On looking at the diseased parts, 1 saw it was a scrofulous affection of 
only eight months' standing. The first phalanx was much swelled, the soft 
parts covering it were livid, and there were three fistulous openings in the skin; 
two corresponding to the dorsal part of the phalanx, and the third to its pal- 
mar surface. They were surrounded with callous vegetations of a brownish 
colour, and communicated with one another by means of subcutaneous fistulous 
passages. By introducing a blunt probe into the sores, it was easy to reach 
the bone of the finger, and to ascertain the detachment of the skin and the 
caries of a portion of the phalanx. The suppuration was serous, yellowish, 
of a faint odour, and contained some flakes of a substance which seemed cari- 
ous. Strong pressure of the diseased tissues occasioned hardly any pain. On 
the back of the hand and the left elbow there was also a swelling of the skin 
and of the subjacent parts, looking like the little finger. The swelling and 
livid patch extended from the elbow to the inside of the bend of the arm; its 
centre was ulcerated, and covered with a thick crust, which, according to the 
patient's report, was renewed every two or three days. 

1 began by sprinkling the acrid principle of monesia on the small sores of 
the finger. After some day's dressing, the swelling of the soft parts began to 
diminish, and at the end of about twenty days the fistulous openings entirely 
closed. The diseased tissues at the back of the hand then ulcerated, and the 
acrid principle being emploj'^ed as above-mentioned, in a few days a cure was 
effected. There remained only the sore upon the elbow, which had been pur- 
posely dressed with cerate. It continued to suppurate, and to be covered from 
time to time with a fresh crust. 

Materia Medica and General Therapeutics. 199 

The patient was in this state when I presented him to Dr. Bally, who had 
been commissioned by the Academy to report on the effects of monesia. The 
affection appeared to him to be evidently scrofulous, and the result obtained to 
be very satisfactory. The disease, however, soon reappeared; the fistula of 
the finger began to suppurate again; there was swelling and livid redness of 
the soft parts, with engorgement and induration of the back of the hand; the 
sore on the elbow became larger and deeper. The patient now entered the 
hospital of St. Louis, where he had internal medicines as well as fumigations, 
sulphurous baths, &c. In a month he came out, with the diseased parts in a 
worse state than ever. I now prescribed the internal use of monesia — namely, 
twelve pills, each containing 20 centigrammes (3 1-2 grains,) and two spoon- 
fuls of the tincture. The sores were dressed with common cerate. Under this 
treatment the patient was cured in thirty-five days. Nevertheless he continued 
to take five pills a-day till the fiftieth day. 

Since July, the diseased parts have been constantly improving, and a lasting 
cure may be hoped for. It is right to state, that in this case the preparations 
of monesia did not cause tenesmus or constipation, although the patient did not 
employ any purgative; the only thing he complained of was too much appetite. 

Case II. — M ,aetat. 40, who had always enjoyed perfect health, came to 

France two years ago, and perceived, in the month of April, 1839, that he had 
an indolent tumor in the left inguinal region. Several physicians of the capi- 
tal were consulted, and they ascertained that it was a swelling of one of the 
superficial lymphatic glands, situated in the bend of the groin. On the 21st of 
the same month, I was also ccnsulted by the patient. The diagnosis was not 
difficult, but the point was to know how the tumor would turn out. My prog- 
nosis was favourable, like that of all the other physicians, excepting M. Lis- 
franc, who thought that the swelling of the gland, though slight, depended on 
a general affection. On the 2d of May the groin continued to swell, and from 
that time all the other glands of that part, as well as of the left iliac fossa, 
swelled considerably; and this was soon the case with those of the opposite 
side. Twenty pages would scarcely suffice to tell all that was prescribed by 

the physicians, and patiently submitted to by M. . No remedy was of any 

use, except for a short time; and I therefore proposed monesia, in the dose of 
150 centigrammes (28 grains) of the extract a-day. The patient at this time 
wai extremely weak, ate but little, and was feverish every day. In a week, 
digestion had improved; there was a sensible increase of strength, and no fever. 
The sores were dressed with the monesia ointment. In consequence of these 
results, I tried to augment the dose of the medicine, and, besides the extract, 
the patient took two spoonfuls of the tincture, and from four to six of syrup in 
an infusion of hops. As to the sores, which obviously grew better, the same 
dressing was continued morning and evening, and every thing promised a speedy 
cure, when constipation and a most painful tenesmus came on, which obliged 
us to suspend the treatment. In a few days the sores became larger and larger, 
fungous, and of a bad appearanee. 

The dressing was then changed — extract of monesia in powder and the tinc- 
ture being employed; but these remedies were almost as useless as a host of 
others which were successively tried. It then seemed clear to me that the 
internal use of monesia had alone produced the improvement, and its use was 
accordingly resumed, taking care to make laxatives a part of the treatment. 
For this purpose the patient had two glasses of Enghien water every morning, 
and an emollient clyster. In a fortnight, the good effects of the monesia were 
again perceived; and this was the more to be attributed to its internal use, as 
the dressing had been performed with simple cerate. 

At present, the swelled glands of the groin are softening and disappearing, 
without any suppuration. Those of the iliac fossa are diminishing in size; the 
sores have cicatrized, and the disease, far from attacking the lymphatic glands 
of the other parts of the body, as is commonly the case, is localized, and is 
much lessened. The patient eats with a good appetite, sleeps well, and takes 
exercise three hours a day, which makes us hope for a fortunate termination 
of the disease. 

200 Pt'ogress of the Medical Sciences. 

Another result v;hich I have obtained from the use of monesia, and which 
has been observed by other practitioners likewise, is its action upon the uterus 
in cases of metrorrhagia. I will give two instances: — 

Case 111. — Madame , of a plethoric constitution, was attacked, after the 

catamenial period, with a flooding, which obliged her to keep her bed and 
seek for advice. After having employed cold drinks, ligatures on the limbs, 
cupping-glasses, and other revulsives, without success, I made the patient take 
five monesia pills, each containing 20 centigrammes (3 grains and 3-5ths.) 
The next morning she was very weak; the skin burning, the pulse scarcely 
perceptible, the face pale, and the eyes sunken. She had shivering fits from 
time to tinie, a sensation of weight in the loins, transient colic pains, and head- 
ache, with sleepiness; and what was more, the hemorrhage did not diminish. 
I then prescribed twelve pills of extract of monesia to be taken every hour. 
The discharge stopped the same day, and never returned. 

Case IV.— Madame , aged 20, who had been married six months, had 

frequent pains in the loins; and in a few days a flooding came on, which 
obliged her to keep her bed. The hemorrhage increased, as soon as the patient 
got up; there was no pain in the abdomen, and no constipation; the pulse was 
weak and irregular, and from 76 to 80 in a minute. Revulsives, cold and aci- 
dulated drinks, clysters of cold water, and compresses dipped in iced water and 
applied to the thighs, had no effect. The ergot of rye was then employed, but 
as this excited vomitings it was discontinued, and pills of the extract of mone- 
sia were ordered to be taken every hour, until an effect was produced. After 
fourteen pills the hemorrhage ceased. The patient then took cold broth at 
intervals, and in spite of the lightness of this food, the discharge returned in the 
evening with violence, and again ceased after the exhibition of ten monesia 

On the following day, the dose of the medicine was diminished to 75 centi- 
grammes (14 grains), and in six days the patient was quite well. 

Quite lately, I employed the acrid principle in powder, in the dose of 15 
centigrammes (2 grains and 7-lOths), taken in a prune; it was to slop a uterine 
hemorrhage, which had suddenly come on during the night; the discharge 
ceased the same day. But as this case stands alone, additional facts are neces- 
sary to prove the power of the acrid principle under such circumstances. In 
every case, monesia acts in a remarkable manner upon the uterus, when it is 
not in its natural state. This new medicine may be used in different ways, 
and it acts on different organs, particularly when they require to be strength- 
ened without too much excitement. 

This is confirmed by the following passages from M. Buchez: — 

*' I have tried the extract of monesia," says this skilful practitioner, " in diffe- 
rent affections of the mouth, particularly in inflammation of the gums, and uni- 
formly with advantage. Its application produced a good effect, by almost 
instantaneously soothing tlie pain, which often accompanies inflammation. This 
mode of treatment 1 have found very successful in the scorbutic swelling of 
diseased gums, and it has removed affections which had previously resisted 
other remedies. WheT\ caries of the teeth is attended with pain, the applica- 
tion of monesid is sure to remove ii in a few moments." 

When all the ascertamed facts are compared together, one is struck by the 
very peculiar tonic action of monesia on every organ. As its powers have 
been tried in more than four hundred cases, we may be allowed to consider 
monesia as a very useful remedy, under several circumstances, particularly 
scrofulous affections and uterine hemorrhage. Hence the art of healing was 
made a real acquisition; nor is it to be imagined that this tonic has any analogy 
with those already known, quite lately a tannin ointment, and monesia ointment 
were tried and compared with each other, and the advantage was on the side 
of the latter. Moreover, it is clear that every medicine acts in its own way, and 
that there can not be two whose special effects are the same. Well-informed 
practitioners know that one purgative can not be indifferently substituted for 
another; that every narcotic has not, in the same degree, the power of soothing 

Materia Medica and General Therapeutics. 201 

and producing sleep; that the action of the various tonics is also very different; 
and that the general effects of medicines are like the difference of faces; many 
resemble each other at the first glance, but none can sustain an exact compari- 
son. — Land. Med. Gaz. from Gazette Medicate de Paris. 

12. Tannin in Hemoptysis. — The superiority of pure tannin o-ver the substances 
which contain it in greater or less proportions, was pointed out three or four 
years since by M. Cavarra. (See this Journal for Nov. 1837, p. 223.) 

It appears from the Journal dc Med. et de Chiriirg. Prat. (Nov. 1839,) that 
this substance has more recently been employed in hemoptysis by Dr. Amedee 
Latour, who highly extols its efficacy in that disease. In one case in which 
other astringents had failed, it perfectly succeeded; and in three others it was 
equally successful, but in these last the hemorrhage was slight. 

He employs the following formula: R. — Tannin, purae, gr. iv; Pulv. gum 
Arab. gr. xvi; Syr. simp. q. s. Misce. — Ft. pilul. No. viij. Four to be taken 
daily (one at a dose, at intervals of three hours) for tv.o days. This article 
occasions constipation which must be removed by enemata. 

13. Utility of JVux Vomica in various forms of Paralysis. — M. Petrequin, one 
of the surgeons of the Hotel Dieu, at Lyons, has recorded his experience of this 
powerful drug, in an elaborate and very practical paper in a recent number of 
the Gazette Medicate de Paris. 

He employs it both internally and externally. He prefers the alcoholic ex- 
tract — prepared with two pounds six ounces of the grated nuts, and 22 pints of 
alcohol — to the strychnine for internal use; beginning with the eighth part of 
a grain for a dose, and gradually increasing it to two, three, or even five grains 
in the course of the day. 

For external use the strychnine is, as a matter of course, to be preferred. 

M. Petrequin alludes to the frequent failure of the endermic use of strychnine, 
owing to the vesicated surface, to which it is applied, becoming covered with a 
layer of coagulable lymph. In consequence of this, the strychnine is not duly 
absorbed. This layer of lymph should be removed as well as possible at each 
application; but, as the vesicated surface becomes daily less and less absorbent, 
the dose of the strychnine must be proportionably increased. The mode which 
M. Petrequin recommends, is to sprinkle a third or fourth of a grain of the alka- 
loid, mixed with two or three grains of the powdered nux vomica itself, on the 
surface, which has been vesicated by means of the pommade ammoniacale. 

Along with the use of the strychnine in this way, he employs a tincture of the 
nux vomica — prepared with four ounces of it in powder and one litre of brandy 
as an embrocation to and around the palsied parts. 

M. Petrequin has related several cases of, more or less complete, hemiplegia^ 
which were either quite cured or greatly relieved by the use of the nux vomica. 

In all of them, the muscles of the palsied parts became affected with sudden 
involuntary twitchings, and the patients experienced electric-like shocks in dif- 
ferent limbs, before the complete recovery of their lost powers. 

Four cases of paraplegia also, in which the strychnos seemed to act most bene- 
ficially, are recorded. 

In the first of these cases, the paralysis was the result of a severe injury of 
the back from a heavy log of wood falling upon it. For three months the 
patient had been confined to bed, when M. Petrequin first visited him. Although 
the sensibility and motility of the inferior limbs had begun to return, and the 
general health of the patient to be somewhat re-established, he was still so 
helpless that he could neither stand nor even support himself sitting in bed.7— 
There was also a complete incontinence* of the urine, so that it was continually 
escaping drop by drop; and, to add to his distress, an ulcer had formed over the 

* For the first three weeks afler the accident, there was a retention of the urine, so 
that it required to be drawn off several times in the course of the twenty-four hours: it 
was very sedimentary, and occasionally almost as white as milk. 

202 Progress of the Medical Sciences. 

A larg-e vesication over the loins was raised by means of the pommade ammo- 
macule, and tne excoriated surface was then sprinkled with a fourth of a grain of 
strychnine, mixed with three grains of powdered nux vomica: this was repeated 
every day. 

Within a week a very decided amendment was visible; for not only was he 
able to sit up for some time, but he also began to retain his urine to a certain 

A fresh blister was twice repeated within the next fortnight, and the dose of 
the strychnine was raised to half a grain. 

By this time he was able to walk a little with the assistance of a stick, and 
he could now hold his urine for two hours at a time. The treatment was perse- 
vered in for some weeks longer, and ultimately the patient quite recovered the 
use of his limb, and command over his bladder. No preparation of the nux vo- 
mica was administered internally. 

In the next case, the paraplegia was connected with a gibbosity of the dorsal 
vertebrae in a youth of 19 years of age, and was accompanied with a retention 
of the urine. 

Three small caustic issues were made on each side of the projection; and two 
pills, containing each a quarter of a grain of the alcoholic extract of nux vom- 
ica, were administered daily. The dose was gradually increased, so that at the 
end of the third week, the patient took three grains daily of the extract. By 
this time, the bladder had recovered in a great measure its contractility, and the 
patient was able to stand with the support of a stick. The treatment was 
steadily persevered in for some weeks longer; the dose of the medicine had 
been increased to seven grains daily, and the recovery was so steadily progres- 
sive, that, at the end of two months from the commencement of the use of the 
nux vomica, the patient was able to run about the ward of the hospital. 

Several cases of local paralysis^ as of one or more of the fingers, of the deltoid 
muscle, &c. treated successfully with the nux vomica — either in the way of 
frictions with the tincture, or of the enderniic use of the strychnine, as explained 
above— are then detailed by M. Petrequin. 

Local anaslkesia also, or loss of sensibility in apart, has in numerous instances 
yielded to use of embrocation with the tincture. 

A woman, 46 years of age, had for four years been affected with a complete 
loss of sensibility along the outer half of the left thigh; she dreaded the cold 
much, and experienced now and then sharp pains in the part which felt to her to 
be quite dead. After the application of a few leeches, the tincture of nux vo- 
mica was rubbed on the part night and morning. In the course of a week, the 
anasthesia had quite ceased. 

Lastly, several cases of amaurotic blindness, which were decidedly and quickly 
relieved by means of friction over the temples with the tincture of the nux vo- 
mica, are detailed at length. It is unnecessary to mention the particulars of 
these cases as they are all more or less like each other. Suffice it to say that the 
remedy is useful only when the amaurosis is simple, and uncomplicated with an 
inflammatory or congestive state of any of the tissues of the eye. — Med. Chirurg. 
Rev. July, 1839. 

* M . P«trpquin mentions that he has treated successfully many eases of nocturnal 
incontinenee of urine occurring in children, with the tincture of the nux vomica, as an 
embrocation to the loins and perineum. Another method, to which he has sometimes 
recourse, consists in the introduction into the rectum of a seton or thick skein of thread, 
well smeared over with a cerate of nux vomica. 

In the Archives Gen^rfdes, for January?, 1836, several successful examples of the in- 
torml use of the medicine are related. 

special Pathology and Special Therapeutics. 203 


14. Pathology and Treatment of Diabetes.— The Revue Medicale for June, 1839, 
contains a memoir on this subject by Dr. Bouchardat, which possesses some 
interest. It is known that in this disease there is a considerable increase in the 
quantity of urine passed, and that one of the most painful attendants is the 
excessive thirst. The sugar which is contained in the urine is the same as the 
sugar from grapes. It results, according to M. B., from the transformation of 
fecula as is effected in the laboratory. The leaven, the gluten, the albumen, and 
the fibrine meeting, the starch in the stomach produces the same result, and the 
author states that he has constantly observed in all diabetic patients, that the 
quantity of sugar contained in the urine was always in direct proportion to the 
quantity of bread or of farinaceous or saccharine aliment which they had taken 
in the twenty-four hours. If then we diminish the quantity of saccharine or 
farinaceous food, the quantity of urine passed, and of sugar contained in the 
urine, will immediately diminish, and in a corresponding proportion. By pre- 
venting, almost entirely, the patient taking this kind of food, the urine will 
gradually be reduced to its natural quantity and normal composition. The 
thirst of diabetic patients is in direct proportion to the saccharine or farinaceous 
food which they take. For a quantity of aliment representing a pound of 
fecula, they usually drink seven pints of water, and pass nearly eight pints of 
urine. If we diminish or withhold saccharine or farinaceous aliments, the 
thirst immediately diminishes in the same proportion. Dr. Bouchardat adduces 
the case of a patient who was astonished to find his urgent thirst completely 
extinguished, on his abstaining from saccharine and farinaceous articles, and 
eating roast beef and salt ham. In fact, the cause of this thirst, which torments 
patients, is easily understood. For the transformation of starch into sugar, it 
is necessary for the fecula to be dissolved in about seven times its weight of 
water. Diabetic patients require nearly as much water, which causes this 
irresistible thirst. 

In the treatment of diabetes, M. B., in admitting the utility of animal food, 
recommends a careful abstinence from farinaceous and saccharine articles of food, 
and that patients should maintain a strict regimen. He may eat certain of the 
legumina, as sorrel, chicory, lettuce, cresses, spinage, &c., and eggs, fish, and 
meat of all kinds. No bread should be allowed at meals, or at most two or 
three ounces. But potatos, rice, beans, peas, lentiles, preserves, and, in a word, 
all substances containing a great proportion of sugar and fecula must be pro- 

A great number of remedies have been supposed to possess the power of re- 
moving the cause of diabetes, but a specific is yet to be descovered. Dr. B. hoped 
much from creosote, for this article prevents the transformation of fecula into 
sugar under the influence of diastasis, but he acknowledges that his trials with 
it have been followed by disappointment. Opium in gradually increasing doses 
succeeds in moderating the symptoms of diabetes, but it evidently acts by lessen- 
ing the a.ppetite, it does not remove the cause of the affection. 

15. On the Treatment of Acute Rheumatism hy Opium. — Eight cases of acute 
Rheumatism cured by opium alone are given in detail by Dr. Corrigan, and 
as the practice appears to be novel, whilst it recommends itself from its sim- 
plicity and general applicability, a short notice of these cases ma)'- be read with 
interest. When he first commenced the opium treatment he was afraid to trust 
it alone, and therefore combined it with calomel; finding that no good resulted 
from this combination, he dropped the calomel, and continued the opium alone. 

Three of the cases are selected to illustrate the mode in which the remedy 
was administered. 

Mr. R., aged 30, was seen on the 19th January, 1838. For several days he 
suffered from flying pains, but for the last three days he has been under the 
most acute suffering from pain in the shoulders, in the back of the neck, along 

204 Progress of the Medical Sciences. 

the loins, in the knee, wrist, and ankle-joints. The knees, ankles, and wrists 
were swollen, and exquisitely painful. He had slept none for three nig^hts; the 
pulse was 132; the bowels free; the tongue covered with a thick white coat; 
the urine very high-coloured, and depositing a pink sediment; and the skin par- 
tially perspiring. One grain of opium with two of calomel were given every 
third hour, and opiate fomentations were applied to the joints. On the next 
day the pains were less, and the pulse had fallen to 120; but he had not slept. 
The opium was therefore increased to a grain and a half every third hour. 

On the 21st he had slept some, and the pulse had fallen to 104. The pains 
were greatly diminished, and the swellings of the joints somewhat lessened. 
The opium was continued in the same dose. Next day he was found to have 
slept well, and the pulse had fallen to 92. The opium without the calomel was 
continued for three days longer in the dose of a grain and a half every third 
hour, at the end of which period, being quite free from pain, and with a quiet 
pulse, he was put on bark. 

Dr. Corrigan attended his friend Dr. Aldridge, who had a very severe rheuma- 
tic attack of three days' duration when he was first seen by Dr. Corrigan. 
Nearly all the large joints were swollen and acutely painful, and the pains 
were shifting from joint to joint. The pulse was 120; the tongue very foul, 
but moist; and the want of rest from the agony of the pain was most distressing. 
He was immediately put on the opiate treatment. He first got one grain every 
two hours; the quantity was then increased to one grain every hour: and this 
was continued for thirteen days, with the administration of an occasional pur- 
gative. On the fourteenth day he began to take the mist, guaiaci c. sulph. 
qvAnx; and on the fifteenth day he was walking about his parlour, complaining 
only of not being so strong as usual, but free from pain and swelling. Dr. 
Aldridge calculated he had taken about two hundred grains of opium during the 

Mr. H. aged 26, had suffered for three days under a very acute attack of rheu- 
matism, /rhe shoulders, wrists, and knees were swollen, and very painful; 
and the pains had been so severe that for three nights he had not closed an eye. 
His pulse were 120 and full; and his tongue moist. He was put on the opium 
treatment, and took every day for six days from eight to ten grains of opium. 
On the seventh day, he began to take along with the opium the mist, guaiaci 
c. sulph. quinae, andon the eighth day of attendance, he only complained of some 
stiffness in the affected joints. His pulse had fallen to 76, and his appetite 
was good. 

In one of his cases pericarditis was threatened, the pulse became affected, 
oppression and constriction across the chest were felt, the countenance became 
anxious, and the patient was bathed in profuse perspiration. These unpleasant 
symptoms subsided under the steady use of the opium combined with a grain 
and a half of quinine to each dose. 

Dr. Corrigan remarks, that "the most important rule to be remembered in 
employing opium for the cure of acute rheumatism is, that full and sufficient 
doses shall be exhibited;" unless carried to this length it is sure to end in dis- 
appointment. He mentions it as a singular circumstance, that sometimes during 
the progress of the cure under the opium, diarrhoea should come on so as to 
require the exhibition of chalk and kino. He recommends the local applica- 
tion of flannel soaked in warm spirit of turpentine, or in camphorated spirit, or 
in simple decoction of poppy heads, to the inflamed surfaces. If the patient 
should suffer much from constant profuse perspirations, he recommends the 
conjunction of sulphate of quinine with the opium. 

Dr. Corrigan thinks this plan of treatment superior to all others, because it 
shortens the duration of the attack, alleviates the sufferings of the patient, hus- 
bands the strength, and prevents the complications of endocarditis, pericarditis, 
&c., which so often complicate this disease, and are the cause of prolonged suf- 
fering ending only in death. 

\_Note. — Several years ago we had an opportunity of testing the efficacy of 
this practice, and found it superior to every other. Large doses of opium were 

Special Pathology and Special Therapeutics, 205 

at first given, not with the view of curing the disease, but of alleviating the 
intense suffering under which the patient laboured. Since then we have 
ennployed it in several cases, and always with the most marked benefit; the 
disease seldom lasting beyond a fortnight, and being much alleviated during the 
whole course of the treatment. — Ed. Med. ^ Surg. Journ. Jan. 1840, from Lub- 
lin Journal of Med. Science^ Nov. 1839. 

16, Saline Enemata in Cholera. — The India Journal of Med. and Phys. Science^ 
(Aug. 1839) contains some strong testimonials from several surgeons, extracted 
from the Madras Quarterly Medical Journal, in favour of warm Saline Enemata 
in the treatment of Indian Cholera. This treatment was adopted at the sugges- 
tion of Dr. Murray, Deputy Inspector of Army Hospitals at Madras. The in- 
gredients used are common salt one ounce; carbonate of soda or potash one 
drachm; water as warm as the patient can bear (120° Fahr.) one pint. To be 
repeated every half hour, hour or two hours until reaction is excited, and the 
pulse rises to a satisfactory degree of strength. 

"Of the modus operandi of this remedy," says Dr. Murray, "I am ignorant. 
Its action is peculiar, however, and is first apparent in its allaying the spasms 
and vomiting, in increasing the volume and diminishing the frequency of the 
pulse, restoring the natural appearance and temperature of the skin, and renew- 
ing the secretions. 

"This eflfect I have seen follow its exhibition, after the pulse was impercepti- 
ble at the wrist and the other symptoms alarming, without the assistance of any 
other medicine. No febrile excitement followed, neither was there any second- 
ary disease developed upon the restoration of the circulation, which leads me 
to think that the disease is not essentially one of inflammatory character, seeing 
that in the reaction after collapse induced by extensive burns and scalds, there 
is violent inflammatory excitement; and if cholera consisted in abdominal in- 
flammation, I should imagine that the repeated use of hot stimulant injections 
would rather develope it; but these, along with bitter laxatives, and an occasional 
mercurial, I have often found sufficient to complete the cure. The last case I 
had was in a drunken European gunner. When I first saw him, he had vomiting, 
his pulse was almost imperceptible at the wrist, his skin was quite cold, he had 
cramps, and his voice was a whisper. The Hot Saline ^Enemata were used, and 
the pulse became stronger, but remained frequent (120); warmth soon returned 
to the skin, and the vomiting and cramps ceased; but no natural secretions ap- 
peared. Mercurial purgatives were therefore given, and the enemata intermitted. 
He again became cold, and the enemata were resumed and continued till the 
pulse rose. Calomel, opium, and castor oil were then given, and the enemata 
again intermitted; but still no natural secretions appeared, the pulse again sunk 
in strength, at the same time that it increased in rapidity (137), and the cold- 
ness of the extremities returned. This was now 48 hours from the time of his 
admission; and late in the evening. The saline enemata alone were ordered to 
be persevered in during the night, and in the morning I found that the secretions 
had become restored, and that he had had' several copious yellow faeculent dejec- 
tions; and after this his cure was soon complete. 1 have tried, and seen used 
most other medicines of the Pharmacopoeia; but, in the advanced stages of this 
disease, their action appears to be merely mechanical — the larger the bulk of 
the dose, the sooner it is vomited. After collapse my sole trust is in the saline 
enemata; and this feeling of confidence in them is indescribably cheering to 

17. Incontinence of Urine. — We extract the following interesting remarks on 
this subject from a paper by Dr. Lendrich in our esteemed contemporary, the 
Dublin Journal of Medical Science (September 1839). "Incontinence of urine 
generally depends on a more or less d^velopement of three agencies. First in 
frequency and generally in date, may be mentioned an irritation of the parts 
about the neck of the bladder, to which the incontinence attendant on calculus, 
disease ..f the prostate gland, fungus, &c., may be attributed, but which may 

No. LI.— May, 1840. 18 

1206 Progress of the Medical Sciences, 

also exist independently of such causes as a primary affection. Sometimes the 
irritation is confined to the part of the bladder immediately behind the prostate 
gland, where the gland by its projection within the cavity of the viscus forms a 
pouch; and in these cases incontinence of urine is often the only symptom that 
attracts notice. In other instances the prostatic urethra partakes of the irritation 
and the patient presents symptoms common to other diseases, among the rest 
irritability of the seminal vessels (after puberty) and frequent discharges of their 
contents. The involuntary evacuation of the urine and semen during sleep, 
seem indeed to be dependent on the same cause, and referable to whatever pro- 
duces irritation in the remote part of the urethra. Thus both are attendant on 
the morbid state of this portion of the passage, so well described by Mr. 

"The second cause, or rather aggravator of incontinence of urine depends on 
the habit which the parts acquire of discharging the contents of the bladder when 
the control of the will is removed, as during sleep; and in many cases of power- 
fully exciting the inclination during the day on the accumulation of the smallest 
portion of the usual stimulus; thus causing diseases designated by the terms 
" irritable bladder," or " irritable urethra," but which are in general confined to 
.the part where the viscus unites with the canal. We often find, that in the day 
time, the patient is perfectly free from annoyance and able to retain his urine, a 
circumstance that proves the frequent independence of the disease of any para- 
lytic affection. Its spasmodic nature is proved by the influence of an opiate at 
night in preventing the occurrence, and by the fact that where a ligature* is applied 
so as to compress the penis, the patient often seems to those appointed to watch 
him to suffer great agony during sleep, while the portion of the passage beyond 
the ligature is found to be distended by the urine forcibly driven against the 

"Thirdly — A more or less paralytic state of the neck of the bladder, which is 
sometimes the cause, is also occasionally the consequence of continued inconti- 
nence of urine. Thus incontinence and retention often alternate, especially in 

"These three causes, or aggravators of incontinence of urine — local irriration, 
the habit of involuntary evacuation, and debility, must be attentively considered 
and the proportionate share of each in the disease duly estimated, before any at- 
tempt to treat it on scientific principles can be adopted. In general the above is 
the order in which these causes arise, and in protracted cases they are usually 
all developed. Thus Sir C. Bell's plan of causing the patient to lie off the back 
during sleep, is well adapted to effect a cure in recent cases, and as accessary 
thereto in others. It ought therefore to be had recourse to in every case. Child- 
ren can be easily subjected to the requisite restraint by a proper arrangement of 
the bed apparatus; and adults are so anxious to get rid of the infirmity, that they 
willingly lend their aid by keeping themselves in the proper posture. 

"Where evidence is afforded of irritation and tenderness about the prostate gland 
leeches may be applied there by means of Dr. Osborne'-s apparatus, or of a small 
and smooth gorget. Suppositories of opium, hemlock, and hyoscyamus may 
also be used. The urine must be kept as far as possible in a neutral state, not 
only by the use of acids or alkalies, according to the results of chemical test- 
ing, but also by avoiding whatever articles of food are found by experience to 
give the fluid a tendency either way. In no class of diseases is it more important 
than in those of the urinary organs to attend to idiosyncracy, to arrange the hab- 
its accordingly, and to regulate the state of the bowels. 

" Bark, steel, cold bathing, &c., are frequently had recourse to in enurests, and 
usually with but little effect; as indeed might be inferred from the rarity of its 
connection with debility, except in advanced cases. Stimulants have been at- 
tended by more fortunate results, and have thus led to an erroneous view of the 
nature of the malady. The reason that stimulants succeed, seems in most cases 

* This practice has been adopted by army surgeons in order to distinguished feigned 
from real enuresis. 

special Pathology and Special Therapeutics, • 20T 

to be similar to the principle on which Mr. Abernethy founded his practice name- 
ly, that where morbid irritation exists, it may be subdued by stimulus or coun- 
ter irritation even applied to the diseased surface; provided care be taken to duly 
regulate the amount, to render it slight at first, and to increase the artificial as 
the morbid irritation subi^ides. In this way cubebs, buchu, &c., probably act. 
The best medicine of the kind is however the uva ursi. The patient may 
take half a pint of the decoction daily, and before each dose two pills formed of 
the resin of copaiba. Where the disease is of long continuance, and attended 
by difficulty of retaining the urine during the day, the twelfth of a grain of ex- 
tract of nux vomica may be added to each pill, and increased gradually to three 
times the quantity, if no unpleassant symptoms should be produced by its use. 
The principal efficacy of blisters to the loins and sacrum is probably attributable 
to the absorption of the cantharides, and their specific action on the urethra. Thus 
the tincture of lytta, taken internally, forms an excellent substitute for the co- 
paiba pills, when the latter begin to lose their effect, especially in those cases 
where the seminal vessels partake of the irritation. The patient may commence 
with half a drachm daily, and increase by one-half, till slight ardor urinae is pro- 
duced when the doses ought to be diminished. 

" Desault treated cases of this kind by means of a bougie, or even by retaining 
a flexible catheter in the bladder. The practice was nearly similar to that of Mr. 
Abernethy although the principle was somewhat different. I have frequently ob- 
served much advantage to ensue from the urine being retained some time before go- 
ing to bed and being then carefully drawn off' by the catheter. Not only the prin- 
ciples of Desault and Abernethy are thus acted on, but also a considerable eflTect 
is produced by the voluntary restraint of the evacuation, and by its subsequent 
accomplishment withoutany counter- exertion of the parts. Indeed in many cases 
of obstinate enuresis, the general health is so good, and the disease is so purely 
local, that local means form the only treatment we can employ with hopes of 
success, and of these, injection of the bladder unquestionably holds the first 

The efficacy of injection of the bladder, in incontinence of urine, seems to de- 
pend on several circumstances — first, when water is injected of the temperature 
of the blood, it produces a sedative effect on the irritable surface, after the first 
impression of a foreign fluid has subsided — secondly, when at a subsequent stage 
the water is used cold, it produces probably a tonic as well as stimulating influ- 
ence, and this at the proper period of stimulants — thirdly, the fluid dilutes and 
thus removes the irritating portion of urine which sometimes stagnates in the 
pouch at the neck of the bladder — fourthly, the bladder acquires, during the opera- 
tion of injecting, the habit of resistance, by which it is enabled at other times to 
withstand the impulse to evacuation. 

Injection of the bladder has fallen into disrepute with many practitioners, on 
account of the great principle that ought to influence us in stimulating irritable 
parts being neglected — namely, so to adapt the artificial irritant to the morbid 
irritability that the irritation produced shall be moderate in amount. It hence 
follows, that where there is much irritation already, our stimulus must be of the 
gentlest kind, and that our treatment can be active only when the disease verges 
on indolence. This treatment requires accurate examination of the constitutional 
peculiarities of the individual, of the progress of the disease, and of the eflfect 
produced by stimulants. In short our treatment must be tentative. 

The patient ought to be somewhat accustomed to the introduction of instru- 
ments before injection of the bladder is attempted; and I have already mentioned 
the utility of such introduction as a part of the treatment, independently of it be- 
ing preliminary to injection. The water ought to be injected through the cathe- 
ter in its flexible state, whether introduced with or without the stylet. An in- 
flexible instrument conveys every motion of the apparatus, or of the operator's 
hand to the urethra, and thus proves a source of irritation. The double barrelled 
silver catheter is indeed better adapted to washing out a dead bladder than a 
Jiving one, A stop-cock should be attached to the flexible catheter after intro- 
duction, to which the injecting syringe is to be fitted so as to slide oflf and on 

208 - Progress of the Medical Sciences. 

either for the purpose of allowing the fluid to escape, or for that of injecting a. 
further quantity of water. A syringe capable of holding- about five ounces is very 
manageable; but the small syringes, used as stomach pumps, produce too much 
irritation by their jerking movement, and a plain syringe of the size I have men- 
tioned is the best. The piston ought to slide smoothly and be moveable by the 
finger and thurrib. Of course the syringe ought to be perfectly clean, so as to 
avoid the risk of introducing a foreign body. An elastic gum bottle can scarcely 
be rendered sufficiently clean for the purpose. 

It is not necessary that the water should be distilled. It ought, however, to be 
previously boiled, and poured carefully from the sediment. On the principle 
that has already been mentioned, the water ought to be blood warm at first, and, 
as irritation diminishes, its temperature should be lowered gradually to that of 
the atmosphere. The patient can seldom bear the injection of more than four or 
six ounces at first, and even this quantity must be thrown in slowly, the opera- 
tor checking his hand the instant the patient complains of any uneasiness, or 
that the slightest impediment is felt. If the piston be pressed further under these 
circumstances, and before the resistance has had time to subside, the bladder is 
excited to spasmodic action, and the fluid must be allowed to escape. If the 
patient can retain the fluid without inconvenience, it m^y be allowed to remain 
and be discharged at his leisure in the ordinary way — If it cause any uneasiness 
a part, or even the whole, must be allowed to run off by the tube. No general 
rule can be laid down as to either the temperature or quantity^of fluid or the 
time it should be retained, further than that the quantity ought never to exceed a 
pint, and that every thing should be regulated by the consideration of not causing 
pain to the patient.* If pain be produced the operation will do more harm than 
good. A similar rule applies as to the frequency of injection, which may vary 
from once per week to once daily. When the patient has become habituated to 
the operation it is a very good plan to cause him to retainthe urine in the evening 
as long as he can, then to draw it off and inject water; and finally to draw off the 
water by the catheter at bed time. In this way the beneficial agency of the opera- 
tion is perhaps brought to bear in the most effectual way. 

Incontinence of urine in the female sex, depends frequently on causes not to 
be influenced by the practice here detailed; it may however prove valuable as a 
palliative. In one case of a very obstinate nature, some years ago, it proved 
highly beneficial; but the patient ceased to be under my care, before I could 
judge as to the probability of a cure being effected. Injection of the bladder is 
indeed to be understood from the preceding remarks, as only a part of the treat- 
ment o( enuresis in either sex; and by no means to be had recourse to indiscrimi- 
nately, or at once in every case, or to be persevered in when the aggravator of 
irritation. Like other remedies it will often act better if laid aside, and renewed 
on a future occasion.' It is highly commended by Sir Charles Bell, as a pallia- 
tive in incurable diseases of the bladder and calculus; and I fully concur with 
him, not only as to its value in such cases, but also as to its efllicacy as a me- 
thod of cure, (especially when aided by other remedies,) in those anomalous 
and yet tractable affections, which so often simulate these diseases. I make 
this assertion however with the qualification, that the aforesaid rules and limita- 
tions be borne in mind, both in the adoption or continuance of the practice and 
in the mode of performing the operation. 

18. On the Employment of Sea Salt {Chloride of Sodium) in Pulmonary Con- 
sumption, Scrofulous affections, ^c. — M. Amedee Latour was first induced to give 

* An operator who adapts his hand with delicacy to the feelings of the patient, 
pressing gently when resistance has ceased; and suspending that pressure when an 
obstacle is felt, or perhaps allowing some of the water to e>c;ipe, will, even during the 
first operation, be able in some cases to insinuate twelve or fourteen ounces into the 
bladder, while another is obliged to relinquish the attempt, after the rude and painful 
injection of two or three ounces, which the patient is forced to discharge at once. 

special Pathology and Special T7ierapeutics, 209J 

a trial to this remedy in phthisis, from its reported efficacy in preventing or curing 
pulmonary complaints among the lower animals. A great mortality prevails 
amongst the apes and monkeys confined in menageries, chiefly from pulmonary 
complaints; and the proprietor of a menagerie found, that by the free use of sea 
salt, he was enabled to preserve these animals in health for seven or eight years; 
and, even after a cough had manifested itself, the administration of the salt was 
followed by a rapid cure. 

^ M. Latour relates three cases in the human subject, in which the administra- 
tion of salt appears to have been followed by the happiest results. In one of 
the cases, the disease had gone so far, that there was distinct cavernous rattle 
with pectoriloquy, muco-purulent and purulent expectoration streaked with 
blood, great emaciation, hectic fever, &c. and yet the patient made a perfect re- 
covery at the end of a fevV months, the sea salt having been given uninterrupt- 
edly for sixty days. 

M. Latour directs a particular regimen to be followed during the treatment. — 
The aliment should consist almost exclusively of beef or mutton grilled or 
roasted, of good rich soups, or animal jellies. The patient should partake of 
these in small quantity at a time, but often, and should drink a little good old 
wine, diluted with water. Every fine day, when the sun shines, and during its 
warmest period, the patient should take gentle exercise in the open air; and his 
chamber should be well aired twice or thrice a day. Flannel is recommended 
to be worn next the skin. 

The mode cf administration of the salt is as follows: Half a drachm to a 
drachm of the chloride of sodium is administered daily, either in a glass of beef 
tea, or in some pectoral infusion, or if this should excite cough, it may be given 
in divided doses made up into bread pills, drmking a little beef tea afterwards. 
It is best to commence with small doses, as the sudden introduction into the 
system of such a powerful stimulant, is apt to be followed by congestions of 
blood in the digestive organs or lungs. A few cresses are recommended to be 
eaten once or twice every week, after having been well sprinkled with common 
salt, but no vinegar or oil is allowed with them. To relieve the pains in the 
chest, and the burning sensations of which the patient complains, instead of the 
usual pectoral drinks he prescribes the following: Carrots are to be well boiled 
in a moderate quantity of water; they are then to be well beaten, and passed 
through a sieve. The fluid which passes through is then mixed with fresh, 
milk, sweetened with a small quantity of sugar, and flavoured with orange-peel. 
This compound the patient drinks at his own discretion. In general some 
thirst is at first caused by the administration of the sea salt, and for this M. 
Latour directs a weak infusion of gentian flavoured with orange-peel. J^din, 
Med. ^ Surg. Journ, from Gaz. des Mededns Fracticiens, 1839. 

19. Case of Scrofula cured by Chloride (f Sodium. — M. A. Latour adduces the 
following case in illustration of the efficacy of sea salt in the <;ure of scrofula. 

A girl, 13 years of age, of lymphatic temperament, suffered, for more than a 
year, under scrofulous symptoms; the sub maxillary ganglia were greatly en- 
larged, and the upper lip was the seat of an extensive scrofulous ulceration, for 
which a variety of remedies had been tried during eleven months without benefit. 

On the 9th of April, a drachm of sea-salt was given in soup, and ordered to 
be continued daily. The sore was washed with salt-water, and the diet was 
confined entirely to animal food. The re-action produced by the salt was so 
great that the dose was diminished by one half, and then continued at that dose. 
The child took frequent exercise in the open air. Towards the middle of May 
the ulcer was healed, and in fifty days a complete cure was obtained. M. La- 
tour recommends that the salt should be given in flour, made up in the form of 
a little French roll. 

Thus a drachm of salt, dissolved in a small quantity of water, may be mixed 
with four ounces of flour. Children will readily eat one or two of these rolls 
in the day.— Lancet, from V Experience, Jan. 9, 1840. 


210 Progress of the Medical Sciences. 

20. Ileus cured hy Injection of Air. — Several cases illustrative of the value of 
the injection of air, in the treatment of Ileus, have been given in this Journal, 
and the follovvinor from a recent Number of the Medicinische Zeitung (No. xxx. 
1839) may be adduced as confirmatory of the same fact. 

A cuirassier, who suffered occasionally from colic, had a very severe attack 
in the beginning of August, 1838, in consequence of having eaten very freely of 
raw bacon, and afterwards drinking cold water. Vomiting ensued, but without 
relief to the pains, which continued to return in the umbilical region with 
considerable violence. Symptoms of decided enteritis followed; the vomiting 
became more severe and fecal; and the obstinate constipation of the bowels could 
not be overcome, even by the administration of pure mercury. In this state a 
quantity of air was thrown into the large intestines, and copious evacuation of 
the bowels followed with instant relief of all the symptoms, the constipation 
having lasted for eleven days. 

21. On a Peculiar Jlffection of the Uvula. — Mr. Edward Thompson describes, 
in the seventh volume of the Trans. Provin. Med. and Surg. JJssociatiun, under 
this title, an affection consisting of an elongation of the mucous coat of the 
uvula produced by the effusion of lymph [scrous fluid?] into the submucous 
cellular tissue; this elongation sometimes going to the length of two inches. 
The fluid contained within the expanded mucous coat is of a light amber 
colour, and so pellucid that the handle of a tea spoon is readily seen if placed 
behind it. The body of the uvula itself appears slightly enlarged, and of in- 
creased redness, as well as the palatine arches; but the tonsils are not usually 
affected. He considers the alteration to be the result of active inflammation of 
the uvula. 

The attendant symptoms are those of simple sore throat in the first instance, 
but afterwards a huskiness of voice, with occasional brief loss of it, are re- 
naarke^. Soon a distressing feeling of suffocation comes on, and, as the elonga- 
tion goes on, the patient runs great risk of being suffocated from the pendulous 
portion passing into the larynx. This in fact is the chief danger, and the patient 
sometimes falls down with every symptom of suffocation. When the throat is 
examined, the pellucid elongation is very apt to be overlooked, as the extremity 
of the body of the uvula is seen red and somewhat swollen. The treatment is 
very simple when the malady is discovered; a simple incision with the lancet, 
or a cut with a pair of scissors, or even entire removal of the pendulous portion, 
if large, being all thatis required. The membrane usually collapses after the 
removal of the fluid, and a very small opening is sufficient in most cases for its 

[We have seen several cases of this affection. The mucous membrane is pro- 
lapsed from the body of the uvula, like a glove partly drawn off from a finger, 
ajid the space is filled with serum. It is a dropsy of the part. We were once 
called up at night to a supposed case of croup in a lady, who was suffering 
from this affection. When recumbent in bed, she was seized with the most 
threatening attack of choakingand difficulty of inspiration, with cough not unlike 
croup. Whilst sitting up, she was exempt from these attacks, but they returned 
again on her lying down. An examination of the throat showed the cause of 
the difficulty. The elongated uvula, doubtless, at times descended into the 
glottis, and caused a spasmodic closure of the part and the attendant symptoms. 
The excision of so much of the membrane as is prolapsed beyond the body 
affords relief.] 


22. Use of Ergot to excite the contractions of the Urinary bladder in order to pro- 
mote the expulsion ff Calculi. — M. Guersant has published in the Annates de la 
Society de Medicine de Gand, two cases in which he has administered ergot with 

Surgery. 211 

the greatest advantage, to effect the expulsion of the fragments of calculi after 
the operation of lithotrity. 

The first case was that of a man seventy-two years of age, whose limbs had 
long been very feeble, and who was subjected to lithotrity in the infirmary of 
Bicetre. He had several small calculi which were readily broken up at four 
operations, but notwithstanding the injections which were employed, lie passed 
but very few of the fragments. With the view of giving tone to the bladder, 
M. G. ordered twenty-four grains of ergot, to be taken in three doses during the 
day. No effect was produced, but the next day the dose having been increased 
to 30 grains the patient experienced frequent desire to urinate, followed by pain 
in the hypogastric region, pricking in the limbs, and slight derangement of 
vision. Alter using the medicine for five days, this old man began to pass 
fragments of calculi, and during twenty-four hours three times as much calcu- 
lous matter was discharged as during the whole previous period subsequent to 
the operation. When fragments ceased to be discharged, a fifth operation was 
performed and several calculi broken, but none of the fragrr^ents were discharged 
the following day. The ergot was then again given and with the same happy 

The second case is so similar to the first that it is unnecesaary to give the 
details. — Journal dt Med. et de Chirurg. Prat. November, 1839. 

23. Epilepsy after an external injury cured by Trephining. — Mr. Cline of 
London successfully treated, several years ago, two cases of epilepsy resulting 
from external injury of the head, by the use of the trephine, and three cases of 
the same description have been related by Professor Dudley of Lexington, in 
which he employed the same measure and with an equally fortunate result.* To 
these we are now able to add two cases more, cured by operation, one related in 
// Filiatre Sebezio, by Dr. Rknzi, the other in Hufelands Journal^ by Dr. Busse. 
Case L A youth eighteen years of age, had been subject since he was lea 
years old, to attacks ol epilepsy; they had resisted every mode of treatment, 
and within the last half year had become so frequent as to return almost every 
week. By falling from a scaffold he sustained a fracture of the frontal bone, 
and also of the left thigh. For five months he was confined to bed. The 
wound of the forehead suppurated and the injured bone exfoliated. During the 
whole period of treatment, there was no return of any epileptic paroxysm; and 
moreover, the patient had quite lost that stupid air so frequent in epileptic 
patients, and his intellectual powers seemed to have become altogether invigora- 
ted. But scarcely was the wound of the head healed than the epileptic fits re- 
turned with fresh violence. A seton however being immediately put in the 
neck, the disease was checked and finally arrested. 

Case H. A youth received some severe blows on the head from his master, 
whom he had displeased. After the immediate effects of the injury had passed 
away, the boy became affected with paroxysms, first of chorea and subsequently 
of decided epilepsy. The frequency of these paroxysms increased so much, 
that at length the patient had several of them every day. On examining the 
head, it was found that there was one spot on the vertex which was excessively 
tender when pressed upon. 

An incision was made from the scalp down to the bone; but no unusual or 
abnormal appearance was perceived. Notwithstanding this, Hufcland recom- 
inended that the bone should be trephined. During the very process of perfora- 
tion, the patient was seized with a fit. An effusion — it is not stated where — 
and a fissure of the internal osseous lamella were discovered. The patient not 
only recovered perfectly from the effects of the operation, but never had any 
return of the epileptic disease. 

His health continued quite good for many years; he married and became the 
father of a healthy offspring. During a period of upwards of twenty years he 
had only three attacks of an epileptic paroxysm; each of these attacks had been 
preceded by indisposition, and had been brought on by mental emotions. 

* See this Journal for August, 1828, p. 489. 

212 Progress of the Medical Sciences* 

2i. Insufflation of Mercurial Powder in the Treatment of Excoriations of the 
Neck ff the Uterus. — M. Trousseau, in a note in the Journal des Connais. Medico- 
Chirurg., states that he has cured a great many cases of superficial ulceration 
of the neck of the uterus, some of which had resisted cauterisation with the 
nitrate of silver by the following- means: Take of protochloride of mercury and 
deutoxide of mercury each one part, of powdered sugar thirty parts. — Mix. A 
speculum is to be introduced into the vagina, the mucus wiped from the mucous 
membrane with lint and long forceps. From four to twelve grains of the 
above powder is then to be applied, by insufflation by means of a glass tube a 
foot long and from three to four lines in diameter. This operation is repeated 
at first two or three times a week, afterwards every four or five days, and, finally, 
every eight or fifteen days until a perfect cure is effected. 

25. Successful Treatment ff Aortic Aneurism by Jlcetate of Lead. By MM. 
DusoL and Legroux. — Aortic aneurism has been always considered to be an in- 
curable affection, the only cases of cure known being the result or natural causes. 
The treatment generally pursued, viz: oft-repeated bleedings and starvation, 
evidently increase the serosity or watery parts of the blood, diminish its coagu- 
lability, and prevent the formation of those fibrous clots on the formation of 
which the cure depends. Dupuytren was amongst the first who recommended 
and employed the acetate of lead in this disease, and his success induced a few 
other practitioners to give it a fair trial. The results of these trials MM Dusol 
and Legroux have laid before the public. Three cases are recorded at length, 
but the symptoms and treatment are so similar in all that one will suffice as an 

Pecheur, 37 years of age, was admitted into the wards of M. Dupuytren in the 
Hotel-Dieu, on the 12th of May, 1829, with a pulsating tumour on the upper 
and right side of the sternum. Three years before, when lifting a heavy piece 
of wood, he experienced a sudden attack of pain with difficult respiration in the 
right side of his chest. He continued to work, however, for fifteen months, but 
the oppresion in the region of the chest augmented, and was attended with vio- 
lent headach, acute pain in the right shoulder, and right side of the neck, and 
along, the course of the vessels of that region. For this he was bled, but with- 
out much relief. After a few months, a tumour appeared on the thorax, which 
gradually augmented in volume till it acquired the size of an Qg^., when it 
became stationary. In proportion as the tumour augmented in volume exter- 
nally, the dyspnoea diminished; but its recurrence forced the patient to apply 
for relief at the hospital. The pulsation of the tumour was perfectly syn- 
chronous with that of the pulse; the skin which covered it was red and stretched. 
There was considerable cough and much dyspnoea, and the patient was obliged 
to maintain the sitting posture. There was facial congestion, difficult degluti- 
tion, and frightful dreams, but the appetite was pretty good, and the bowels 
were regular. Blood-letting to the extent of seven or eight ounces having 
afforded no relief, M. Dupuytren ordered two pills, each containing one grain of 
the acetate of lead. On the following day, and every day after, he took six pills; 
and from this moment annelioration of all the symptoms took place, so that by 
the 1st of June the tumour had almost completely disappeared, and the other 
symptoms were much relieved. 

The number of pills was gradually increased to ten daily, and compresses 
dipped in a saturnine lotion v/ere applied over the tumour. This treatment was 
continued till the 29th of June, when it was discontinued, from its exciting 
nausea and vomiting. It was again renewed on the 4th of July, and continued 
till the 19th, when the patient left the hospital, feeling himself quite well. 

The amelioration in the three cases related was so remarkable and rapid, 
that it cannot fail to induce similar trials to be made in this country. Opera- 
tions on the larger vessels near the heart for the cure of aneurism have very 
generally been unsuccessful, and any thing which could give a chance of life, 
particularly without undergoing the danger of an operation, should be eagerly 

Surgery. 213 

adopted. — Ed. Med. and Surg. Journ. Jan. 1840, and Archives Genirales de Med. 

26. On the Treatment of Varix of the Inferior Extremities. 1. By Pins. 2. 
By Caustic Potass. 3. By the (hmbination (f these means. By M. Bonnet, First 
Surgeon of the Hotel Dieii of Lyon — In 1834, I commenced, says M. Bonnet, 
to study the subject of the radical cure of varices. Irj the following year, I 
employed pins in sixteen cases, in which the veins were in relief beneatli the 
skin, and caustic potass in two cases of females, in which the dilated veins 
were lost in a large quantity of fat. The last two were cured, as well as all 
those who were treated with pins, and who were in such a condition as to ren- 
der a radical cure certain. Both methods appeared to me equally useful. But 
as hemorrhage had occurred through the eschars at the time tliat the caustic had 
opened the veins, and as no serious accident had followed the use of pins, I 
came to the conclusion that the operation by pins was to be preferred. But I 
determined to watch the progress of these cases; and the consequence was, that 
1 was disappointed in the effect of the pins. All the patients whom 1 saw again, 
after having remained well during a time varying from one to six months, were 
reaffeeted with varix, with as much intensity as before the operation, and this 
not only in the secondary divisions of the veins, but in the trunk of the saphena, 
on which the larger number of pins had been applied, and where it appeared 
that the obliteration would be permanent. In two cases treated by caustic 
potass, there was no return of the disease: one of these was seen fourteen 
months after the treatment, the other several years afterwards. From these 
facts I was led to infer, that the pins produced but a temporary obliteration; 
but that caustic potass determined a permanent closure, its u«e, however, being 
attended with risk of hemorrhage. 1 considered, therefore, that if I placed 
pins at intervals upon the saphena, and cauterized the vein between them, I 
should obtain a temporary obliteration by the pins, such as would prevent 
hemorrhage, and a permanent obliteration by caustic, such as would effect a 
cure. I employed this treatment on nine patients, in 1837, but these cases I 
never saw again. But. in 1838, 1 treated a man in whom the ulcerated varicose 
veins gave rise to abundant hemorrhage. I had lost confidence in pins, and 
found the combination of pins and caustic too complex. I had, therefore, 
recourse to caustic alone, believing that bleeding might be controlled by com- 
pression and position. 7^he result of the practice, in this case, having justified 
my expectations, I resumed a practice, which 1 immediately employed on a new 
series of twelve cases, the course of which more and more confirmed me in the 
idea, that the treatment of varices by caustic alone is, of all the methods which. 
I employed, the most simple in its application, the least uncertain in its effects, 
and that which secures the most complete and the most permanent cure. 

Before further considering the question of treatment, which is the mam object 
of this paper, I would notice a fact in morbid anatomy relative to varices, and 
a symptom from which their importance and the effects of treatment upon them 
may be inferred. I speak of those tumours which stand in the same relation 
to veins that spontaneous aneurisms do to arteries, and of the undulation which, 
may be communicated to the blood in varicose veins, in a contrary direction to 
that which happens when the valves are entire, and the blood takes its normal 

Faricose Tumours analogous to Spontaneous Aneurisms. — I removed one of 
these tumours from the course of the internal saphena vein; it contained a quan- 
tity of liquid blood, with soft and blackish clots; its fibrous walls were per- 
fectly smooth on their internal surface, and its cavity communicated with that 
of the vein by an opening, three or four lines in diameter, which surrounded 
the small portion of the vein which I had detached. This tumour was like an 
aneurism; its walls were continuous with those of the vessel on the side of 
which it was situated, and the cavities of the one and of the other communica- 
ted by a narrow aperture. I have since met with this affection in two instances, 
and each time on the crural porlion of the internal saphena vein. On percus- 

214 Progress of the Medical Sciences, 

sing one of these tumours, the blood was made to flow backwards in the dilated 
vessel, and on placing^ the hand upon the other, a distinct pulsation was felt, 
which pulsation was also visible. This reflux, this pulsation, seems to me to 
be the distinctive character of the tumours; because it shows that the fluid con- 
tained in them communicates freely with that in the veins This form of varix 
has been very little mentioned by authors. The two cases just mentioned were 
treated simply by passing a pin through the bloody mass: it was secured by 
the twisted suture, and not removed, in either case, for eight days. The blood 
began to coagulate on the second day; on the eighth, the swelling had become 
hard, and in about a month it was very hard, and of the size of a small nut. 
This [ regard as a successful issue of the treatment of these tumours by means 
of pins. The undulation of the blood caused by percussion of varicose veins 
should be very carefully attended to, both as a mean of judging of the difficulty 
which may attend the radical cure of varix, and especially to ascertain whether 
or no, when pins have been employed, they have been employed properly; for 
if the pins properly compress the opposite sides of a vein, the undulation of 
blood stops at the place so compressed. This sign should also be attended to 
at the conclusion of the treatment, as a mean of judging if the treatment 
requires to be renewed. 

Treatment of Varices by Pins alone. — Velpeau, Davat, Jobert, who have writ- 
ten on the treatment of varices by pins, have not specified the cases in which 
they necessarily fail, and in such cases as failure does not happen, to what 
extent the cure is permanent; nor have they insisted on the principles on which 
this treatment is founded. These defects it is my intention to supply. 

In the treatment of Varices^ it is necessary to obliterate the veins in several points 
separated from each other by short intervals. — The necessity of this is admitted, 
depending, as it does, on the numerous anastomoses of the venous trunks. 
It is easy to find, in various works, instances of continuance or recurrence of 
varix, after the obliteration of a vein in one place alone, whether this oblite- 
ration was spontaneous, or artificially eflfected. On the other hand, in addi- 
tion to written evidence of an opposite character, all the observations which I 
have made on the obliteration of veins, either by pins or by caustic potass, have 
but confirmed me in the opinion, that veins should be oblrterated in several 
points. I have always observed, that the coagulation of the blood, and the 
contraction of the vein, took place only in the vicinity of the obliterated points; 
that the divisions of the veins distant from those which the operation had 
rendered almost impermeable to blood, remained almost as dilated as before the 
operation. 1 consequently have been in the habit of obliterating at as many 
points as possible, placing from four to ten pins on the same individual, some on 
the course of the internal saphena, from three to four inches apart, others at the 
point of junction, or upon the course of the principal divisions connected with it. 

Methods of placing the Pins. — There are three principal methods. That of M. 
Davat consists in plunging the pin upon the middle part of the vein which is to 
be obliterated, passing it through from the superficial to the deep part, and 
again in a contrary direction. When the point of the needle protrudes, it is 
fixed by means of a thread, twisted as in the twisted suture, and it is allowed 
to remain until the parietes of the vein, in contact with one another at the divi- 
ded part, become inflamed and adherent. This plan is easily enough effected 
by means of common pins, when the part to be transfixed takes an oblique 
direction in relation to the axis of the limb. In this case, after having trans- 
fixed the vein, the head of the pin being depressed, its point is passed for two 
or three times behind the vessel, which is again transfixed with ease, from 
withm outwards. But when the vein runs parallel to the limb, as is commonly 
the case in the thigh, it is difficult, without giving an oblique direction to the 
pin, to pass it properly, so that after having transfixed it inwards, the pin may 
not enter it in coming outwards, but may pass behind it. The method of M. 
Velpeau consists in passing a pin transversely beneath a vein, without wound- 
ing its parietes, securing it afterwards by means of the twisted suture. M. 
Fricke simply transfixes the vein with a pin, and allows it to act as a seton in 

Surgery, 215 

the production of adhesive inflammation. The method of M. Davat appears 
the most efficient of these three: it ensures inflammation, compression, and the 
contact of the parietes of the vein, in those parts which the pins have divided. 
M. Davat considers that it is very important to slightly divide the membranes 
of the vein, before putting them into contact. He thinks M. Velpeau's method 
insufficient, that it simply produces coagulation which may not be durable. 
He dissected the jugular vein of three dogs, which he had operated on in the 
manner described by M. Velpeau. In one case the pins were withdrawn on 
the eleventh day; in the other two cases, on the ninth. In the first case, the 
vein was thickened for the extent of an inch, a fibrous cylinder occupying its 
cavity, which was contracted but not obliterated. In the other two cases, the 
course of the blood was re-established, the veins being simply thickened. 
Other experiments of M. Davat show that obliteration depends upon adhesive 
inflammation, that the cicatrices are durable, and not dissipated with the other 
effects of the inflammation. 

Period during which I have left the Piw^ in place. — I have never waited for the 
establishment of suppuration before removing the pins. When the red tume- 
faction and pain around the pin commenced, I cut the thread, and as soon as 
the swelling and redness were very marked, and the pain such as to disturb 
sleep, I removed the pin. The time required for the production of these symp- 
toms varied from three to fifteen days. In one case only, having neglected to 
take away a pin which caused great pain, and which had produced, on the 
fourth day, a swelling, the surface of which was somewhat larger than a six- 
pence, an active inflammation occurred in the upper half of the leg. This was 
of a phlegmonous character, requiring very active means to prevent suppuration. 
This, and other cases, induced me to remove the pins before suppurative inflam- 
mation took place. 

Result obtained by treatment of Varices by Pins alone, — These cases may be 
thus classed: 1. Varices without ulceration of the vein, without oedema, the 
vessels being easily visible, and capable also of being felt throughout their 
whole course. 2. Varices very much folded on themselves, resembling, in this 
respect, the intestines. 3. Varices accompanied by cp.dema, and losing them- 
selves in a quantity of fat. Eleven patients belonged to the first class; two of 
these were more than sixty-three years of age, and were debilitated. The cure 
was not even momentary, the blood did not coagulate in the interspaces of the 
pins, and before they left the hospital, the obliteration, the existence of which 
was known by the stoppage of the undulation, even after the removal of the 
pins, was completely destroyed. These facts are not astonishing. In advanced 
life, the blood is indisposed to coagulate, adhesions are indisposed to form; and 
no attempt should be made to cure varices after the age of sixty years. The 
other nine were, with one exception, under fifty-four years of age: they left 
the hospital quite cured; the blood was coagulated in the whole course of the 
varicose vessels; these were diminished in size, and a very long walk did not 
cause swelling of the veins. But, of these nine, I saw five again. In two of 
these, the veins began to enlarge and to become permeable, as soon as the 
patients resumed their occupations; in two others, two or three months after- 
wards, and in the fifth, six months after his having left the hospital. One or 
two months more were required in each case, before the dilatation was as much 
as before the operation. I'he patients of the second class were almost com- 
pletely cured: some few venous branches only swelled whilst walking. In one 
of these, fifteen months afterwards, the internal saphena and its branches had 
become as large as before the use of the pins. In the two other cases, in which 
the veins were very large, lost in a great quantity of fat, and spread in large 
number over the whole leg and instep, although in one of these I applied twelve 
pins, and in the other fourteen, which were not withdrawn until from the eleventh 
to the fifteenth day, only a momentary benefit was obtained. One of these 
patients was sixty, and the other forty-eight years of age. The same failure 
occurred in two patients, whose varices were imbeclded in fat, and were attended 
with oedema. Of the twelve patients regarded as cured on leaving the hospi- 

216 Progress of the Medical Sciences. 

tal, the six whom I saw afterwards suffered a relapse, after a longer or shorter 
period. There were among these some whose veins were most acutely inflamed, 
and where the cure appeared to be complete. 

It is an important question, How do veins once obliterated become again perme- 
able to blood? — Phlebitis obliterates veins: 1. By infiltration of serum into 
their surrounding cellular tissue, and into the substance and on the surface of 
their proper tunics. 2. By the secretion of organizable matter in the same 
parts. 3. By coagulation of blood. It is evident that a diminution of inflam- 
mation will account for the re-establishment of the current of blood. But M. 
Davat asserts, that by his method an inflammation is excited, which gives rise 
to adhesion of the opposed venous surfaces, by a fibrous tissue, and that this 
adhesion is indestructible, as is shown by experiments on dogs. But it is not 
certain that the adhesion which takes place in the veins of dogs will also occur 
in varicose veins, ^fhese no longer possess their normal texture; they are 
changed into a fibrous tissue, having but little disposition to secrete organizable 
matter, and consequently to contract adhesions; the inflammatory phenomena 
occur rather in the healthy cellular tissue around than in the substance of the 
veins themselves. These considerations explain clearly the want of adhesion, 
and the merely temporary obliterations which, at first sight, appear somewhat 

Varices treated with Caustic Potass. — Caustic has been long employed in the 
treatment of varicose veins; but the principles of its correct application have 
not been laid down. The following are the rules which have guided me in the 
treatment of varix by caustic potass: 

1 . It is necessary to apply several morsels of caustic potass on the course of the 
dilated vein^ and at a distance of three or four inches from each other. This is 
a repetition of the principle already laid down in speaking of the treatment by 
means of pins. 

2. The caustic potass should only be applied to the veins at such points as these 
correspond to the muscles. Other situations than these are unfavourable to cica- 
trization, and if cicatrization takes place, the ulcers are readily renewed. The 
situations which I prefer, are, — 1, for the thigh, at the height at which caute- 
ries are commonly applied, but a little backward, in consequence of the situa- 
tion of the vein; 2, for the leg, at the height commonly chosen for cauteriza- 
tion; 3, the middle of the thigh, or the middle of the leg, if three applications 
should be necessary. In each case, it is supposed that the vena saphena is 
alone affected. 

3. // is necessary to apply the caustic at least twice., in order to reach the vein. 
This supposes, that in order to obliterate the veins, it is necessary to open them 
by the caustic. All the cases which I have observed, have convinced me that 
this is a fact. The undulation of blood has never ceased after the first applica- 
tion, which has only implicated the skin and subjacent cellular tissue. The 
conversion into a hard and impermeable cord has never happened, until after a 
second application. Would it be better to destroy sufficient at once, or by 
making two successive applications, to make the second application in the cen- 
tre of the eschar produced by the first? The reply is not doubtful, if it be con- 
sidered that it is sufficient to open the vein, and to destroy it to the extent of a 
few lines, and that any further destruction is useless. A single piece of cau- 
stic, which would reach the vein, would make a large eschar of the integu- 
ment; but with f- small piece, tv/ice applied, the part may be hollowed out with- 
out extensive destruction of the surface. We should wait three or four days, 
before applying the second piece of caustic. The plan then is, to make a cru- 
cial incision through the eschar, and to insert the caustic into this incision. 
After the second application, the blood escapes. It is possible, that even a 
third application may be required to open the vein, but this has always been 
sufficient. In this way I have applied the caustic, both wiien I employed it 
alone, and when I conjoined with it the use of pins. I have employed this 
treatment in fourteen cases, with different results as it regards the cure of the 
disease, but always without serious effects. 

Surgery. 217 

We pass over M, Bonnet's observations on the cases in which he employed 
both caustic and pins, because he gives the preference to the treatment by the 
former alone. 

Caustic potass applied over veins does not expose the individual to phlebitis^ i. e. 
to that kind of phlebitis which extends from the part operated on towards the 
trunk. Of course a certain amount of local inflammation is essential to the 
cure. In advancing the above proposition, I am supported by the fourteen, 
cases in which the potass was employed alone, and by six others where it was 
combined with pins. Here are twenty cases, in none of which was the inflam- 
mation disposed to pass along the veins, although three or four applications of 
caustic were made in their course, most of which opened their cavities. The 
patients were simply confined to bed, taking their usual diet at the same time. 
General facts are also in support of the opinion which I derive from my expe- 
rience. These facts show that cauterization limits all inflammations which are 
disposed to extend. 

TAe application of caustic potass is followed by a circumscribed inflammation^ 
and by ulcerations which are slow to cicatrize. — In the cases where several pieces 
of caustic are applied very near each other, the inflammations which surround 
each eschar run together, and the consequence is a true phlegmon. 

2%e application of caustic potass exposes to hemorrhage; but this hemorrhage may 
be easily avoided^ if the patient keeps his bed, and if a slight compression is exer- 
cised around the limb. — It has been already said, that it is necessary to apply 
the caustic until a slight escape of blood shows that the vein has been opened. 
There may be an actual hemorrhage instead. How long should a patient re- 
main in bed, to render him safe from all chance of hemorrhage'? This can 
not be fixed by days, but must depend on the condition of parts. When the 
vein is opened, and this is known by the escape of a few drops of blood, the 
blood coagulates beneath and above the perforated part; the vein becomes hard, 
and percussion communicates no undulation to the blood. These signs, which 
demonstrate the obliteration of the vein, show that there is no further chance of 
hemorrhage. Four or five days commonly suffice for the accomplishment of 
these phenomena. In order to second the effects of rest, a bandage should be 
applied around the limb, immediately after the application of the second piece 
of potass. The neglect of this was, in one case, followed by hemorrhage, one 
hour after the application of the second caustic. But a roller immediately 
stopped the bleeding. No other patients treated with caustic potass, who kept 
their bed, and to whose limbs a roller was applied, suffered from any hemor- 
rhage worthy of the name; the eflTusion of a few drops of blood alone announced 
that, the vein was opened. 

In the varices which are limited to the internal saphena and its divisions, and 
which affect persons within sixty years of age, caustic potass produces a complete 
and permanent cure. — The fact of the completeness of the cure rests on four- 
teen cases. Those which are related, leave no doubt of the superiority of can-.- 
terization compared with the employment of pins, as a mean of effecting the 
obliteration of veins. In one case only was there not a complete interruption 
to the current of blood in the vein. 

The cure of varices by caustic potass, or by any other means, should not be at- 
tempted when the internal and external saphena veins are dilated. — In the only 
two cases in which the caustic was applied to varices of both saphense, it wa& 
observed, that whilst the internal saphena was obliterated, the external saphena 
acquired an increase in size, and that varices previously but li- le apparent, be- 
came more voluminous, so as to substitute a new disease ^ i that which had 
been cured. Advanced age, and the thickness of the coats of veins, &uch as 
renders their approximation difficult, even with the pressure of the finger, are 
likewise circumstances unfavourable to the use of caustic potass. 

The treatment of varices by caustic potass hastens the cicatrization of ulcers 
which co-exist with them. — This may in part be explained, by the revulsipn 
caused by the numerous artificial ulcers, and by the cure of the varices. 

In what cases should cure of varicose veins be attempted? 

No. LI.— May, 1840 19 


218 Progress of the Medical Sciences, 

1. Whenever varices ulcerate, and give rise to hemorrhage. 

3. "When varices exist with ulcers so extensive as to require rest of six weeks, 
two months, or upwards. 

Setting aside these complications, I think we should attempt to diminish the 
swelling by a stocking. If there are no ulcerations, or if these are but little 
extensive, if they may get well in one or two weeks, it is unnecessary to keep 
the patient in bed for above a month; this time is necessary for the separation 
of the eschars formed by caustic potass, and for the cessation of the pain which 
remains for some time afterwards in the deep ulcerations. In this case, the 
remedy would indeed be worse than the disease. M. Bonnet concludes the 
above highly interesting and useful memoir, by an eulogium on the superiority 
of the treatment therein recommended over every other, and by a prediction that 
it will gain the credit which it deserves. — B. ^ F. Med. Rev. hova Archives Gene- 
rales, May and June, 1839. 

27. Rigidity of the Lower Jaw — Operation — Cure. — We find in the Compte 
rendu des travaux de la Societe Roy ale de Medecine de Toulouse, by the Secretary- 
General, M. DucASSE, the following interesting case. A soldier, setat. 29, was 
affected with scurvy, and languished for several months in the hospitals of 
Africa. He was afterwards sent to France, where his health was completely re- 
established; but there remained a permanent rigidity of his jaw, so that he could 
not separate them more than half an inch without intolerable pain. Hence 
there was great difficulty in mastication and in speaking. After a protracted 
and fruitless treatment, this patient was admitted into the Hotel Dieu-Saint- 
Jacques of Toulouse on the 15th of March, 1838, a year after the commencement 
of this affection. 

M. DiEULAFOY, after a careful examination, concluded, that the immobility 
arose from a permanent contraction of the right masseter muscle; the patient 
experiencing pain in this part when it was pressed upon, and also when efforts 
were made to separate the jaws. The left side was unaffected. M. D. believing 
that the accident might be remedied by a division of the muscle, determined 
to perform such an operation. 

He accordingly made a vertical incision through the skin three or four lines long 
ahout the middle of the muscle. Through this he then passed a narrow bladed 
and strong bistoury which was alternately moved from before, backwards and 
then in the opposite direction, so as to divide the masseter. Immediately after 
the operation, the rigidity of the jaw was in part relieved, and the patient could 
open and shut his jaws much better than previously. In a few days the external 
wound cicatrised, but the motion of the jaw was still limited. It was then 
found that there existed a band, which extended from the superior to the inferior 
alveolar processes behind the last molar, and that the anterior fibres of the 
pterygoid muscle were contracted. These were divided, and the patient was 
relieved; he could perform with facility all the usual movements of the jaw, 
and, in a short time, left the hospital cured. — Journ. de Med. et de Chirurg. Frat, 
Aug. 1839. 

28. Fast Mortem Appearances in Prof. Salomon's Patient, whose Friviiiive 
Iliac Artery had been '• d. — Our Number for August, 1838, contains an account 
of a case in which Prof. Salomon, of St. Petersburg, had succesfuliy applied a 
ligature to the primitive iliac artery, near the bifurcation of the aorta, for an 
aneurism of the external iliac artery. The cure was deemed perfect; the tumour 
almost entirely disappeared, and the free use of the limb was restored. After 
remaining well for ten months, the patient exposed himself to the cold in the 
open air during a stormy night, with but little clothing on. Rheumatic inflam- 
mation of the psoas muscle was brought on, and, though treated b}' the most 
energetic antiphlogistic means suppuration could not be prevented. An abscess 
formed, and was opened three weeks from the beginning of the symptoms, just 
below Poupart's ligament. He died shortly after, worn out by the suppuration. 

Before examining the body, the abdominal aorta was injected. Inspection 

Surgery, 219 

showed that pus was collected along' the psoas, beneath the fascia iliaca, and on x 
the outer side of the femoral vessels. The iliacus internas muscle was as it 
were dissolved by the ichorous pus, and the internal surface of the ilium was 
exposed. The abscess had formed outside the peritoneum alon^ the outer por- 
tion of the aneurism; but the pus had not passed inwards to the fe.noral ring; at 
this part there was a fibrous mass which remained from the internal portion of 
the aneurism. No fibrous clot was found; it had no doubt been already com- 
pletely absorbed. 

The injection had passed into both legs. It was easy to see by the contracted 
and firmly adherent part of the left common iliac that it had been tied about 
half an inch below the bifurcation of the aorta. It was converted into a liga- 
mentous cord throughout its whole length. A little of the injection had passed 
into the left external iliac through the medium of the left internal iliac artery. 
The maintenance of the circulation was chiefly effected by the very dilated lum- 
bar arteries, whose branches anastomosed with those of the left circumflexa ilii. 
The lower extremity was also in a great measure supplied with blood through 
the free communications between the two internal iliacs. The left femoral 
artery was injected to within two inches below Poupart's ligament. The com- 
mon, external, and internal iliacs, on the right side, were considerably dilated; 
and in the left thigh it was chiefly the ischiatic and obturatrix arteries that had 
increased in size. — Zeitsch.fur die gesanu Heilk, and Gaz. Medicale, Dec. 1839. 

^ 29. Tumour of the Parotid Gland. — Extirpation. By Dr. Brett. — The pa- 
tient was an interesting young female of 17 years of age. The disease com- 
menced five years ago by an inflammatory swelling in the region of the parotid 
gland: an abscess burst, and continued to discharge for some time from the me- 
atus auditorius. This subsided, but the swelling increased, and the abscess 
then obtained an exit by the parotid duct. On the cessation of this, the tumour 
rapidly increased, until it acquired such a size as to occasion great deformity 
and to impede the functions of deglutition and voice, and to be attended with 
considerable pain; the integuments were perfectly healthy. 

Some of the best surgeons deny the necessity of securing the carotid artery, 
whilst others of equal celebrity advocate the expediency of so doing. 

In the case I am about to describe, a ligature of reserve was introduced under 
the carotid artery. 

The operation for extirpation of the tumour was then commenced through the 
integuments and platysma myoides muscles by two semi-elliptical incisions, ex- 
tending from the zygomatic process. to the inferior part of the tumour, and with 
a little dissection, the whole extent of the tumour was exposed. The lateral 
attachments were dissected, and the tumour was laid hold of, and detached from 
its firm connections, a great part of which was effected by the finger. The 
hemorrhage was thus far but slight, the few vessels which were wounded being 
easily secured at the moment they were divided, and nothing of moment occur- 
red, until the dissection was carried to the deep attachments at the base where 
it encircles the artery. At this point, in an instant was the patient almost de- 
luged in a torrent of blood chiefly from the external carotid. She swooned, and 
involuntary discharge of urine and faeces took place. In a moment the ligature 
on the carotid artery was secured, which was followed by instantaneous cessa- 
tion of the hemorrhage. The patient shortly revived from the syncope, and 
completely recovered; without the occurrence of any subsequent hemorrhage. 
The dissection clearly exposed, in this case, the posterior belly of the digastri- 
cus. The transverse processes of the cervical vertebrae, the mastoid process and. 
meatus auditorius on the one side, and the angle of the jaw with part of the 
masseter muscle on the other, and the hyoid and pterygoid processes were dis- 
tinctly felt. The circumstance of the early abscess discharging itself through 
the parotid duct appears to me diagnostic. 

^ The wound completely healed chiefly by adhesion, and partly by cicatriza- 
tion, and the girl presented herself to me, some months afterwards, in perfect 
health . 

220 Progress of the Medical Sciences. 

I was assisted at the operation by Mr. Corbyn, Garrison Surgeon of Fort 

The structure of the tumour was partly glandular, and partly of an indurated 
scirrhous character, having several small cysts throughout its substance con- 
taining purulent matter. The lobules of the conglomerate parotid were quite 
distinct, and its figure and superficies entire and well defined. It was examined 
by Dr. Gcodeve, and myself, and 1 think that gentleman has preserved a prepa- 
ration of it, in the Calcutta Medical College. 

Branches of the portio dura of the seventh pair of nerves were unavoidably 
wounded, in consequence of which there was paralysis of the muscles furnished 
by these motor nerves. — India Journ. of Med. and Phys, Science, Aug. 1839. 

30. Treatment of External Cancer by Ligature of the Vessels and Division of 
the Nerves supplying the diseased part. By M. Jobert. — Feeling persuaded that 
the increased afflux of blood and heightened nervous sensibility, which are the 
consequence of disease, exert a great local influence in cancerous affections, 
M. Jobert has adopted a new plan of treatment; namely, that of tying the prin- 
cipal arterial branches and dividing the nervous filaments which are distributed 
to the aflfected part. He has seen this proceeding followed by a favourable 
change in the aspect of the ulcers, and by their ultimate cure. He has ob- 
tained this successful result in four cases of cancer of the lip, and in one of 
the tongue. 

M. Jobert is of opinion that the vascular system has a much more important 
share in the development of cancerous aflTections than the nerves of the part; 
therefore he considers that tying the arteries will have much more influence in 
checking the progress of the disease than the division of the nervous filaments. 
— B. ^ F. Med. Rev. from Revue Medicale, Sept. 1839. 

31. On a New Universal Interrupted Splint. By Alfred Smee, Esq., late 
Dresser at St. Bartholomew's Hospital. — Compound fractures of the leg, at St. 
Bartholomew's Hospital, are treated by placing the limb upon a back iron 
splint, about an inch and a half broad, and of such a thickness that it may bft 
Lent to accommodate itself to the limb; it is turned up towards one end, at nearly ^ 
a right angle, to form a point to which the foot may be fixed by a bandage; at 
the point corresponding with the heel, there is a hole, to prevent any undue 
pressure on that part which might give rise to troublesome sloughs. Imme- 
diately above this aperture is a piece of iron, about an inch broad and one foot 
long, which is rivetted at right angles to the principal piece: this is simply to 
allow it to rest firmly on the bed. Above this attachment the splint is bent to 

a convexity, to adapt it to the concavity above the heel, and then it is rendered 
concave to suit the convexity of the calf; again it is convex, to fit into the 
hollow behind the knee. The whole splint is covered with a pad to render it 
soft, and, if much discharge is expected, the pad is protected by oil silk. 

There is an advantage in this position for most compound fractures of the 
bones of tlie leg wherever they may occur; and it is even useful in many serious 
comminuted injuries. In these cases the powerful action of the muscles of the 
calf has a tendency to throw the two ends of the bone forward, especially when 
the fracture is about the centre of the limb. This bowing is immediately 
remedied by placing it upon the splint just described. In these cases the leg 
is further fixed by two flat wooden splints, one on either side of the limb, ex- 
tending from the foot to above the knee, and these are also covered with a pad; ' 
the whole is then confined by straps with buckles. 

In compound fractures, where the bone is separating, or where ulcerations or 
gangrene is taking place, it is olten necessary to apply a poultice, the water 
dressing, or various lotions, such as the chloride of soda. In these cases the 
interrupted splint is used on the side at which the ulceration is taking place; it 
is formed of two pieces of wood, united by a strip of iron bent at two right 
angles, so that the two pieces of wood have an interval of a dimension suitable 
the extent of the sore. 

Surgery, 221 

Now, in these interrupted splints, are three variable elements; first, the gap 
requires to be of different extent in different cases, or even in the same case at 
different periods; secondly, the wood below the gap requires to be longer, or 
shorter, according to 'the situation of the sore; and, lastly, the length of the 
piece of wood about the sore is required in the same way to be altered. These 
circumstances vary to such an extent in different cases, that it is customary, at 
St. Bartholomew's Hospital, to send to the carpenter to have a new splint made 
for each accident. 

To obviate the delay and inconvenience attending this proceeding, a splint, 
adapted to meet these exigencies in every part of the leg, was devised. 

The wood of which the splint is formed should be hard, and of a thickness 
sufficient to make it quite firm; two inches and a half will be found most conve- 
nient for its breadth. Jn order that the two pieces of wood on each side the gap 
may be of different length, pieces are united at their edges by moveable joints. 
This mode of junction should be very firm, and requires particular description. 
A piece of brass of the same breadth and depth as the wood is to be taken; 
in this, four holes are made to allow the brass to be screwed firmly to the 
edges of the wood. The pegs, about an inch long, and of a thickness suffi- 
cient to give strength, are rivetted in the brass, so that when the brass is 
fixed on the edge of the wood, these two pegs project. Another piece of 
brass, of exactly the same size as the last, is now to be procured, and, in a 
situation corresponding to the pegs, two holes are to be bored in which the 
pegs can fit with accuracy. Four other holes are now to be made for the pur- 
pose of screwing it firmly to the edge of the wood. The situation of these pegs, 
with their corresponding holes, is important, for in every joint they must be 
fixed exactly in a similar position, and to effect this the holes must all be made 
to a guage, and the pegs rivetted with like accuracy. By this contrivance we 
have a number of similar joints of such strength, that pieces of wood can be 
firmly united by their edges. The difficulty of adjusting these pegs and holes 
to each other exactly, is obviated by taking a small piece of twine and putting 
it into the hole, which will be found to make the junction firm. 

Having considered the breadth and width of the wood, and the joints by 
which the pieces are united, the next point is to mention the length of each 
separate piece, which should be of such a size that the greatest variety of adapta- 
tion should be obtained with the fewest possible joints. Four pieces of wood 
are first to be taken, each 1^ inch long, and 3 broad, and | deep; these on one 
edge are to have one part of the brass joint fixed; the other edge is to be rounded 
off. Two of these pieces are to have the brass with the pegs fitted on, and the 
other, the two holes in which these pegs fit. These pieces form the four ends 
of the wood-work of the splint; one piece being applied at the upper part of 
the splint, another at the upper end of the gap, or interval for the sore, the tliird 
at the lower end of the interval, and the last at the end nearest the foot. On the 
two which form the boundaries of the gap, the brass pieces for regulating it are 

Thus it is manifest, that having these four pieces of wood, the wood would be 
three inches above the interval, and three inches below it. Now, other pieces 
are wanted, to fit on in such a way that each part may be extended one, two, three 
four, five, or more inches, according to circumstances, or, in other words, we 
want pieces of wood so that two arithmetical series in inches should be formed. 
Now, advantage is taken of the properties of the geometrical series, the sum of 
which formed an arithmetical one; but though we want two arithmetical series 
to make the splint quite complete, it will be found that for every practical pur- 
pose pieces of wood of the following lengths will suffice: Thus they must be + 
one inch, two inches, three inches, five inches, and seven inches respectively, 
and, by combining these, great variety can be produced at the part below the 
gap, which we have already seen, is three inches, may, by the addition of these 
pieces, be extended to four, five, six, up to eighteen inches, and the part above 
the gap can be increased in a similar way. 

The mode by which the interval is increased, or diminished, is by two pieces 


222 Progress of the Medical Sciences* 

of brass. One of theso is about three inches in length, and terminated at one 
end by a square flat piece, to be screwed into the wood work; the other piece of 
brass has a similar termination at one extremity, to be screwed on the wood, 
the rest is circular, and has a bend at right angles, at three inches from the ex- 
tremity last described; from this bend the brass is continued about eight inches, 
and is of a size corresponding with the ring in the ))orlion first described. Into 
this it fits, and by sliding to and fro the aperture is augmented, or contracted, 
as required, and it is secured in its situation by screwing in the first piece of 
brass. This mode of adjusting and fastening is similar to that of the ring of 
a retort-stand on its support. 

The splint thus constructed, fulfils every purpose for which it was designed, 
not theoretically alone, but practically, for its complete strength has been proved 
in the cases to which it has been applied during the last year, in the wards of 
the hospital attended by Mr. Lawrence. Its adaptation, as an interrupted splint, 
to every part of the leg, has been tested, and it can also be used as a simple 
splint when required. — Lancet, Jan. 25, 1840. 

32. Hydrocele of the Neck. — Those encysted tumours of the neck which have 
been sometimes designated hydrocele of the neck, although mentioned in the 
writings of some of the older authors, had attracted little notice, until M. Mau- 
noir of Geneva published, in 1825, his work entitled " Memoires sur les Ampu- 
tations, I'Hydrocele du Cou, et I'Organisation de Tlris." M. Delpech subse- 
quently narrated, in his Clinique Chirurgicale, two cases which he had success- 
fully treated by operation. Messrs. Lawrence, O'Bierne, Heidenreich, Beck, 
&c. have since published the reports of a few additional instances of this rather 
rare disease, and have thus contributed to enlarge our knowledge of its true 

According to the researches of MM. Fleury and Marchessaux, in the August 
Number of the Archives Generales de Medecine, there are two sorts of these 
tumours, which may be distinguished from each other by the difference in their 
anatomical characters. 

The_^rs/ are those which are developed in the actual tissue or substance of the 
thyroid gland. They are sometimes superficial, at other times deep-?ieated: they 
correspond to the cellular or thyroidean serous goitre of Beck and Heidenreich, 
to the hydrocele of the neck of Maunoir, the hydro-bronchocele of Percy, and 
the encysted goitre of other writers. 

The second are developed in the common cellular tissue of the neck, at a 
greater or less distance from the thyroid gland, and, according to some authors, 
in the cellular texture of this gland itself. These have been denominated by 
O'Beirne hydrocele of the neck, cystic tumours by Boyer and Dupuytren, fibro- 
serous cysts by Delpech, and hygroma cellularis by several German surgeons. 

MM Fleury and Marchessaux have given a very minute description of the 
anatomical peculiarities of these two sorts of tumours. Those which more 
properly appertain to the thyroid gland, had already been ably treated of by 
MM. Andral and Beck. 

The other kind, or such as are developed in the cellular tissue, are genuine 
encysted swellings; the cysts of which are formed by the progressive develop- 
ment of a fibrous tissue, which, as Bichat first demonsirated, exhibits many of 
the characters of serous membranes. The skin over them does not usually un- 
dergo any change, except perhaps when it adheres very firmly to the subjacent 
cyst; and then it becomes so very thin, from the absorption of all the fatty mat- 
ter, that the minute blood vessels can often be seen through it. At other limes, 
the cyst is connected with the surrounding parts only by very loose cellular- 
tissue, so that it remains very moveable. The parietes of the cyst are usually 
firm, little or not at all elastic, and thickened. The thickness is sometimes re- 
markable: in one case the anterior wall of a cyst was found to be nearly an inch 
in thickness. Not unfrequently within their cavity are found laminae of a car- 
tilaginous and even of an osseous formation. 

These characters are always the more decided in proportion to the length of 
time that the swelling has existed. The internal surface of the cyst, when its 

Surgery. 223 

aspect is not completely modified by the transformation which it has underjrone, 
exhibits a white, reticuiatod appearance, not unlike to the inner surface of the 
ventricles of the heart, or of the urinary bladder in certain cases. This surface 
is coated throughout with a pseudo-serous membrane, which invests all the 
ridges and furrows, and which some anatomists have described under the name 
of internal lamina of the cyst. Its thickness, colour and consistency vary much 
in different cases: in some it is smooth and of white colour, while in other cases 
it is more or less red, and resembles a softened mucous membrane. Occasion- 
ally pieces of this lamina become detached, and, floating about in the fluid of 
the sac, have been mistaken for hydatids. 

The encysted tumours of the neck have been met with in both sexes, and at 
almost every period of life: sometimes they are congenital. Their growth is 
usually very slow; and in most cases no cause can be assigned for their appear- 
ance. Occasionally they have been observed to enlarge rapidly after a catarrh, 
and also after an accouchement. 

If allowed to attain a large size, they impede the respiration, and even the 
deglutition, as well as the circulation in tlje neck and head. 

The fluctuation of their contents is generally more easily perceptible in the 
earlier stage of the disease — provided the tumour be sufficiently prominent — 
than when it is more advanced, in consequence of the parietes of the cyst gra- 
dually becoming thicker and more resisting. Hence mistakes in diagnosis have 
occasionally been made by the most experienced surgeons, and cases of hydro- 
bronchocele have been considered as examples of goitre, or some other solid 
growth. We may also mention that the tumour may sometimes be mistaken for 
an aneurism of the carotid artery, in consequence of its communicating the pul- 
sations of this vessel; but a careful examination of the case will generally en- 
able the surgeon to discover that the swelling experiences"a lifting up or rising 
en masse, and not those movements of alternate expansion and retrocession, which 
are characteristic of a genuine anuerism. 

With respect to the different methods of treating hydrocele of the neck, au- 
thors very generally agree in regarding /jMndwre as a mere palliative means, and 
as one moreover not always free from inconveniences; and they condemn injec- 
Hon of the sac, as uncertain in some cases and highly dangerous in others. The 
use of a seton or something analogous, as a canula, tent, &c. appears to be the 
practice most extensively approved of. 

In one of the cases, which occurred to Dupuytren, the sac refille I to its former 
size within a short time, although a seton had been in it all along; a canula of 
elastic gum was therefore introduced and left in the lower opening, so as to per- 
mit a ready escape to the contents of the sac, and at the same time to allow the 
occasional injection of emollient and detersive washes. 

MM. Fleury and Marchessaux also record a case, in which the same method 
was adopted with success, after various other means had been ineffectually tried. 

In a case, which occurred in a girl 17 years of age, M. Jobert punctured the 
tumour three times successively, the fluid having re-accumulated quickly after 
each operation. After the third puncturing, some alcohol ised water was injected 
into the sac, and then a seton was introduced for the purpose of keeping the 
wound open. At the end of a week, suppuration was but imperfectly estab- 
lished, and there was only a slight serous oozing, when the seton was removed. 
An elastic-gum canula was therefore substituted for the seton: this was kept in 
the opening, and gently stimulating injections were repeatedly passed through 
it. After the lapse of two months, the swelling, which had been of an immense 
size, was not bigger than an egcr; and four months later, all that remained was 
a small kernel or lump, which was entirely indolent. 

M. Flaubert, of Rouen, has published a case which he successfully treated by 
incision — a method which has succeeded in the hands also of MM. Delpech, 
Morelot, Lemaire, and which an Italian surgeon has in one case combined with 
the use of the seton. ~(j?«/ja/t Unioersali, Feb. 1838.) 

Excision has been repeatedly adopted with complete success. In three cases 
Beck, after having laid open the tumour by an incision, excised a portion of the 

224 Progress of the Medical Sciences, 

cyst, which was not connected with the thyroid gland. This method hastens 
the process of suppuration, and does not seem to be attended with any incon- 
veniences, when precaution is taken to avoid wounding the substance of the 
thyroid gland. 

The extirpation of the entire sac may be adopted with advantage, when the 
cyst is small, superficially seated, and not firmly adherent to the thyroid gland, 
or to any other of the neighbouring important parts. 

M. Jobert practised it with success in the case of a woman, 30 years of age, 
in whom the tumour was of the size of a hen's egg, and was smooth, hard, and 
so resisting that it communicated no feeling of fluctuation; the wound healed 
up by the first intention, the twisted suture having been employed to retain its 
lips together. But we must refer our readers, who may wish to make them- 
selves acquainted with the particulars of the various cases on record, to the ori- 
ginal paper of MM. Fleury and Marchessaux, and will now extract only the 
following conclusions, which they have deduced from their inquiries. 

1. The encysted tumours of the neck may be arranged, according to their 
anatomical position and relations, in two classes — one comprising such as are 
developed in the substance of the thyroid gland, and the other, all those which 
are developed in the cellular tissue of some portion of the neck. 

2. Thejirst set seems to be attributable to the hypertrophy of one or more of 
the cells of the thyroid gland, and, if so, cannot be regarded as encysted tumours, 
in the strict sense of the phrase; whereas in the second set, the sac of the tumour 
is a genuine cyst of a sero-mucous nature. — {Delpech.) 

3. This distinction is important both in a diagnostic and in a therapeutic 
point of view. 

4. The tumours of the first class may be readily mistaken for genuine goitre; 
and those of the second for chronic abscesses, lymphatic swellings, or aneuris- 
mal swellings. 

5. Encysted tumours of the neck, whatever be their nature, should never be 
left to Nature; they always require surgical assistance for their dispersion. 

6. Among the various methods of treatment, which have at different times 
been proposed, that of nearly puncturing, and that of injecting the sac, appear 
to be the least trustworthy and advisable. The employment of a seton, after a 
free incision has been made, has been found useful in tumours of the first class, 
by inducing and keeping up a long and abundant suppuration, and thereby caus- 
ing a melting down of the hypertrophied and swollen tissues; also in all cases 
where the cyst was multilocular, by giving a free discharge to the contents, and 
preventing an accumulation in any of the cells. On the whole, it may be laid 
down as a therapeutic principle, that the incision of the swelling and the sub- 
sequent employment of some means to establish suppuration in the cyst, seem 
to be the best method of treating almost every encysted tumour of the neck, 
whatever be its origin or seat. 

The complete extirpation of the sac may be recommended when this is not 
very large nor closely adherent to the surrounding parts. — Med. Chirurg. Rev. 
and Archives Generales de 31ed., Aug. 1839. 

33. Application to Blistered Surfaces. — Sir Benjamin Brodie employs the fol- 
lowing preparation as an application to blistered surfaces when they become 
irritable and painful; B. Creta pp. Ol.Oliv. aa^v; Aq. Ros. ^ij. Lancet. 

34. Dislocations of the Humerus and Fractures of the Head and Neck of that Bone, 
The last number of Guy's Hospital Reports contains an essay of Sir Astley 
Cooper, upon dislocations of the os-humeri and on fractures of the head and neck 
of that bone, which, as being of a practical character, and emanating from one 
who at the same time that he is the acknowledged head of European surgeons, 
has devoted himself in a particular manner to the study of luxations, and frac- 
tures about the joints, is entitled to especial attention. Since the publication of 
his last work on luxations of the shoulder, several cases of dislocations on the 
dorsum scapulae have come to the knowledge of Sir Astley, as also an example of 

Surgery, 225 

the post mortem appearances presented in these cases. Backward dislocations of 
the head of the humerus are, he ohserves, usually produced by a violent push of 
some opposing body while the arm is advanced, and probably in these cases 
the posterior part of the capsular ligament is torn, permitting the escape of the 
bone upon the dorsum of the scapula and its inferior costa. The principal 
symptoms which make known the existence of this accident, are a depression 
below the acromion, a projection formed by the head of the humerus behind the 
glenoid cavity, which when the elbow is rotated will be found to obey its mo- 
tions, and the close approximation of the elbow to the side. 

The common mode of reduction in such cases, is to fix the scapula and draw 
the arm outwards from the body, but finding the reduction to be slowly and 
with difficulty effected by this means. Sir Astley employed the following method 
with success. The case was one of twenty-three days standing occurring in a 
gentleman who had received his accident in a scuffle. He says, " I placed the 
patient upon a chair, and bending his elbow at right angles, I raised his arm, 
and carried it behind his ne-tk, so as to bring the hand across the back of the 
neck to the opposite shoulder; then forcing the elbow back, and pressing upon 
the head of the bone, 1 pushed it under the inferior costa of the scapula, and it 
instantly returned into the glenoid cavity." Other means however will succeed; 
in a case at Guy's Hospital, the patient was placed in a chair with the knee in 
the axilla, while extension was made by an assistant from the wrist, and the 
bone was reduced. In another instance, it is stated that Mr. Dunn, easily suc- 
ceeded by fixing the scapula and extending from the wrist in the usual mode of 
reducing a dislocation into the axilla. Dr. Physick, we may add, in one in- 
stance succeeded in effecting the reduction, by making extension and counter ex- 
tension in the usual manner, at the same time that the head of the bone was 
pressed towards the glenoid cavity. Th& method above described as adopted 
by Sir Astley, will not always succeed as he shows by a case communicated to 
him by Mr. Key, which fell under the observation of that gentleman in August 
last in conjunction with Mr. Whittaker. The patient was a very stout man who 
received his injury by a fall upon his shoulder. " At first," says Mr. K. "we 
placed our patient, on a chair and while Mr. W. fixed the scapula, I carried the 
elbow upwards and bnckwarda, in ordpr to throw the head of the bone forwards 
into the glenoid cavity, but to no purpose. All that we gained by this measure, 
was a slight advance of the bone and reducing him to a state of syncope. In 
this state we laid him upon his back; and fixing his scapula by the heel in the 
axilla, drew the arm downwards; and by extension continued for a minute or 
two, succeeded in reducing it." 

The case in which Sir Astley had the rare opportunity of witnessing the post- 
mortem appearances after this accident, was that of a person stat. 5*2, who was 
subject to fits of epilepsy, in one of which, occurring while in bed. his shoulder 
was dislocated by muscular action alone, it having been well ascertained that 
he neither fell from his bed, nor struck his shoulder during the fit. Another pe- 
culiarity of this case was, that the head of the bone could be by extension drawn 
into its natural situation, but so soon as the force ceased to be applied, it slipped 
back upon the dorsum scapulae. Although the patient lived seven years after 
the occurrence of this accident, he never recovered the use of the limb. The 
appearances presented on dissection are thus described: — "The head of the os- 
humeri was placed behind the glenoid cavity of the scapula; and it rested upon 
the posterior edge of that articulatory surface, and upon the inferior costa of the 
scapula, where it joins the articulation. When the scapula was viewed ante- 
riorly, the head of the os humeri was placed in a line behind the acromion, but 
below it; and a wide space intervened between the dislocated head of the bone 
and the coracoid process, in which the fingers sunk deeply towards the glenoid 
cavity of the scapnla. 

" When viewed posteriorly, the head of the os humeri was found to occupy the 
space between the inferior costa and spine of the scapula, which is usually 
covered by the infra-spinatus and teres-minor muscles. The tendon of the sub- 
scapularis muscle and the interior portion of the capsular ligament liad been torn 

226 Progress of the Medical Sciences. 

at the insertion of that muscle; but the greater part of the posterior portion of 
the capsular ligament remained, and had been thrust back with the head of the 
bone, the back part of which it enveloped. 

"The sapra-spinatus muscle was put upon the stretch; the subscapularis di- 
minished by want of action; and the infra-spinatus and teres minor muscles 
were shortened and relaxed, as the head of the bone carried their insertions 
backwards. The tendon of the long head of the biceps muscle was carried 
back with the head of the bone, and elongated; but it was not torn. 

" As to the changes in the bones, the head of the os humeri and the outer edge 
of the glenoid cavity of the scapula were in direct contact, the one bone rubbing 
upon the other when the head of the os humeri was moved; and this accounted 
for the sensation of crepitus at the early period of the dislocation, as there was 
no fracture. The glenoid cavity was slightly absorbed at its posterior edge, so 
as to form a cup, in which the head of the bone was received; and this latter 
bone, and the articular cartilage, had been in some degree absorbed where it was 
in direct contact with the scapula, as well as changed by attrition during the 
seven years the patient lived. 

" The surface of the original glenoid cavity, instead of being smooth and car- 
tilaginous, was rough and irregular, having elevations at some parts, and de- 
pressions at others." 

Of Fractures of the Head and Neck of the Os Humeri. — As these injuries often so 
closely resemble dislocation, as to lead to errors in their diagnosis and treatment, 
Sir Astley has thought it well to bring together the observations which in the 
course of his long and extensive practice, he has had an opportunity of making 
concerning them. These accidents are of three kinds: 

1. Dislocations of the os humeri into the axilla, with fracture and detachment 
of the head of the bone, which is thrown on the inner side of the inferior costa 
of the scapula. This accident is always the result of great violence to the 
part, and the signs of it resemble closely the symptoms of simple dislocation of 
the head of the humerus into the axilla. In order to distinguish it from luxation, 
it must be recollected, 1st. That the depression of the shoulder is less marked 
than in that accident, the end of the shaft of the bone filling the glenoid cavity. 
2d. That upon raising the arm the head of the bone can be felt in the axillu, 
though it does not roll upon rotating the elbow; 3d. That a grating sensation, 
and sometimes a distinct crepitus can be felt from the neck of the bone rubbing 
against the glenoid cavity. 4th. That the broken extremity of the humerus is 
drawn forwards towards the coracoid process, but that it is readily pushed back 
into the glenoid cavity from which it easily again slips forwards. 5. That the 
arm measured from the acromion to the elbow is shorter than that of the oppo- 
site side. In the treatment of this fracture, all that can be done is to bring the 
broken shaft of the bone, into the glenoid cavity and retain it there, where it 
will form a useful joint, though some of the motions of the arm will be lost. — 
To effect this purpose a pad must be placed in the axilla, a clavicular bandage 
used and the fore arm supported in a sling. Of cases of this nature, Sir Astley 
has seen, as he believes, many in the living and has dissected three of them, 
and can consequently describe them as they appeared on dissection as well as 
give the appearances they present during life. The post-mortem appearances of 
one of these cases we shall transcribe: 

" The deltoid, teres-major, and coraco-brachialis, did not appear altered.— 
The supra-spinatus was somewhat wasted, as was the teres-minor; and their 
colour was fainter than natural. The infra-spinatus was put upon the stretch. — 
The subscapularis passed over the bead of the bone, and adhered to its cartila- 
ginous surface. 

"The fractured neck of the shaft of the os humeri was seated in the glenoid 
every other part was entire. 

" The head of the os humeri had been broken off; and was found in the axilla, 
behind the coracoid process of the scapula, and it was strongly united to the 
inner side of the scapula. 

*^ The capsular ligament had been torn, under the subscapularis tendon; but 

Surgery. 227 

the cavity of the scapula, widely separated from the head of the bone; and the 
broken os humeri formed a new and good articulation with the glenoid cavity, 
with a capsular ligament over it, which was in part newly formed. A ligamen- 
tous matter passed from the broken end of the os humeri to the inner surface of 
the glenoid cavity of the scapula. 

"The edge of the glenoid cavity remained; but its surface was rather ligamen- 
tous, than smooth and cartilaginous. 

*' The greater tubercle of the os humeri had become enlarged; the tendon of the 
biceps remained in the biciptical groove; and the tubercles were connected 
with the broken extremity of the shaft of the os humeri, and not with its head." 

In the second kind of fracture through the neck of the bone, at the tubercles, 

the head of the humerus is broken otf, but it remains in the glenoid cavity 

This fracture occurs at the anatomical neck of the bone, at the part at which the 
capsular ligament is fixed, and where in young persons the epiphysis is placed. 
Fracture at this point is most frequently met with in children, and is usually the 
result of falls upon the shoulder. The accident. Sir Astley has known to have 
been mistaken for dislocation; from this however it maybe distinguished by the 
following symptoms: Is^t. The shoulder is not sunken as in luxation. 2d. The 
end of the broken bone is felt at the coracoid process, and this is supposed to be 
the head of the humerus, but with care the head of the bone can be feft filling 
the glenoid cavity: 3. By extension the projection is removed, but immediately 
reappears when the extension is removed: 4. Motion of the shoulder is painful, 
and the elbow is with difficulty removed from the side. In old persons fracture 
through the anatomical neck of the bone is comparatively rare. The best method 
of treatment consists in the application of splints to the front and back of the 
arm and the use of a clavicular bandage with a pad in the axilla. In a case 
which occurred to Mr. Tyrrell, he could not succeed in removing the deformity 
or in keeping the bone in its place, until the arm was raised and supported at a 
right angle wiih the side, by means of a rectangular splint, a part of which 
rested against the side, while the arm reposed upon the other part. An instance 
of what the writer of this analysis believes to be an example of this accident, 
very recently came under his notice. The patient was a young man who had 
fallen down the hold of a ship at Rio Janeiro and struck his shoulder. Great 
swelling and pain followed, and as the vessel to which he was attached, sailed 
the day after his accident, no treatment other than that of keeping the arm in a 
sling, was pursued. Upon his arrival in Philadelphia, six weeks afterwards, 
the shoulder presented the following appearances. Measurement of the arm 
from the acromion to the elbow showed it to be shorter than that of the opposite 
side: the arm could not be lengthened by extension, and the elbow could be 
brought down in close contact with the side: the shoulder had not lost its natural 
rotundity; but an irregular projection existed at its upper front part which rotated 
with tiie arm. The parts allowed of considerable motion, and there was every 
reason to believe that a very useful though deformed articulation would even- 
tually be formed. 

In the third kind of fracture of the shoulder, the hone is fractured in its surgi- 
cal neck, viz. between the tubercles and the insertion of the pectoralis major, 
coraco-brachialis, latissimus dorsi, teres-major and the deltoid muscles. In this 
fracture there is no depression under the acromion, the head of the bone being in 
its cavity, but the fractured extremity of it is drawn upwards and forwards under 
the pectoral muscle. The elbow may be moved more freely in all directions 
than in the other injuries about the shoulder, though all motion of it is accom- 
panied with much pain. 

In the treatment of this case, splints, the clavicular bandage and the pad in the 
axilla are required, and Sir Astley particularly recommends that the arm be per- 
mitted to hang by the side, unsupported at the elbow so as to let the weight be 
a constant source of extension. G. W. N. 

35. Extirpafion of an Encephahid Tumour of the Testicle weighing nine pounds, 
M. Ph. BoYER, Surgeon to the Hopital St. Louis, presented to the Academy of 

228 Progress of the Medical Sciences, 

Medicine at their meeting on the eig'hth of October last, a testicle, converted into 
an enormous encephaloid tumour weighinj^f more than nine pounds which he 
had successfully extirpated fourteen monihs previously. The spermatic cord 
was healthy; the wound healed in three days and the patient continued in health 
up to the present time. — Revue Medicale^ Nov. 1839. 

36. Venereal Excrescences treated hy n-atery solution of Opium. — M. Venot, of 
the Venereal Hospital, Bourdeaux, having been disappointed in the various re- 
medies which he had employed for the treatment of venereal vegetations, deter- 
mined to try the efficacy of the narcotic lotions, recommended by M. Desruelles. 
His experiments were most successful, and from them he draws the following 
conclusions: — 

1. The solution of opium should be fresh and concentrated, an ounce of water 
containing at least one drachm and a half of opium. 

2. The white dry epidermoid vegetations do not yield so readily. 

3. All cases of mucous ve^jetations, moist warts, condylomata, &;c., are al- 
most certainly cured by the watery extract of opium, especially if employed 
after general treatment. 

4. The local action of the remedy is manifested in the following manner: — 
the veg'etations dry up, become pale, then yellow, brown, and finally waste 

5. This action, which is evidently poisonous, may extend to ihe healthy parts 
and determine certain accidents, against which the physician must be on his 
guard. — Lancet, from Gazette Med. de Paris, Jan. 13, 1840. 


37. Case of sudden and tempnrory occurrence of Presbyopia in a young Boy. — 
Dr. James Hunter has recorded a curious case of this character in \\\ej Edin^ 
burgh Med. and Surg. Journ. for Jan. last. The subject of it was an intelligent 
boy, 9^ years of age, who had been three years at school, and was very fond of 
his books. His sight began to fail about three weeks before Dr. H. saw him, 
and was so mtich impaired in the course of four days that he could no longer 
see to read ordinary type with the naked eye. He had never had inflammation 
or other disease of the eyes, nor received any local injury that could have caused 
this affection. His general health had always been good, and he never felt bet- 
ter than at the time when his sight gave way. Dr. H., on the most minute ex- 
amination, could detect no visible symptom of disease. There was no vascu- 
larity of the tunics; the size and shape of the pupils, the motions of the iris, 
eyeball and eyelids were perfectly normal, and he felt no pain or uneasiness. 
He could see distant objects as well as ever, but near ones appeared very indis- 
tinct. With the assistance of his father's spectacles, which were fitted with 
glasses of nine and a half inches focal distance, he could read the smallest print. 

The patient was ordered an active dose of calomel and rhubarb and afterwards 
an aperient of senna and salts twice a week, a spare diet, active out-door exer- 
cise—to be kept from school, and not to be allowed to use spectacles. Exactly 
three weeks afterwards his sight began to improve, and in the course of two 
days was quite restored. The medicine had purged freely — no worms were 
discharged. The boy can now read as well as ever without glasses. 

After discussing the several proximate causes of presbyopia. Dr. H. very 
correctly, we think, considers that, in the present case, it was a derangement of 
the mechanism for adjustment. 

"All things considered," he remarks, '•! think the best explanation of this 
case is to suppose that there was some derangement of the mechanism by which 
the eyes are accommodated to the distinct vision of objects at different distances. 
When the eye is turned from a distant object to the contemplation of a near one, 

short interval elapses before the latter is seen distinctly; this interval being 

Midwifery* 229* 

occupied in the adjustment of the focus of vision. During this process the only 
visible change is a slight contraction of the pupil; but all physiologists agrea 
that some other change must lake place The lens must either become more 
convex, or move forwards, or the antero-posterior diameter of the eyeball be 
lengthened, or the cornea become more prominent, or perhaps there is a combi- 
nation of all or of some of these modes of adjustment. As all the above ac- 
tions imply a power of contraction and relaxation in certain internal structures 
of the eyeball, it is very probable that the movements of these parts should at 
times be subject to derangement from spasms or from over-relaxation, in the 
same way as other organs endowed with a contractile power; and therefore, I 
think it not unlikely that, in the present case, the eyes had temporarily lost the 
power of changing from the state necessary to fit them for the distinct vision of 
distant objects to that state required for the distinct vision of near ones: but 
whether that change is to be regarded as a contraction of certain parts, such as 
the ciliary ligament, as some suppose, or the fibres of the lens, as believed by 
others; or in a relaxation of these or other parts, cannot be determined in the 
present imperfect state of our knowledge of the exact manner in which the eye 
is adjusted to distance. This view of the case is supported by the following 

" 1. The affection and recovery of the two eyes were simultaneous and equal. 
as might be expected if the presbyopia depended on a spasmodic derangement 
of their adjusting apparatus, which, being destined to act simultaneously and 
equally in health, is likely to be similarly affected in disease. 

" 2. The vision of distant object-* was perfect, and near objects were seen quite 
distinctly with convex glasses; showing the sensibility and other functions of 
the retina to be unaltered, and that the cause of the disease was one that did not 
interfere with the functions of the eyes, excepting by depriving them of their 
power of adjustment to distance. 

"3. Other cases of the sudden occurrence of presbyopia in young children 
have been traced to the existence of various disorders, such as intestinal worms, 
epilepsy, and diseases of the brain or spinal cord, all of which are known to be 
frequently accompanied by spasmodic atTections of different organs. 

"The treatment of the present case was very simple; but 1 would call par- 
ticular attention to the necessity in all similar cases of strictly prohibiting the 
use of spectacles in the first instanci^ for they can always be resorted to at an 
after period should the affection prove a permanent one; and I have but little 
doubt that, if the wishes of my patient had been complied with, and he had 
been allowed to continue to use his father's spectacles, the presbyopia would 
have become a confirmed disease." 

38. Hydrochloride of Baryies in Scrofulous Ophthalmia. — Dr. Payan of Aix, 
in an article in the Revue Medicale for April, 1839, extols the eflBcacy of the 
hydrochlorate of barytes in scrofulous ophthalmia, and in a communication in 
the Journal de Med. et de Chirurg. Pratiques^ for Jan. 1840, he adduces four 
cases to support his judgment of the powers of that article. 

His formula for its administration is as follows: — R. Baryt. Hydrochlorid. 
gr. ij, (gradually increased to gr. x;) Syr. simp, ^ss; Aq. purae ^iij. M. A 
tablespoonful to be given every two or three hours, so that the whole may be 
taken during the day. 


39. Inversion of the Uterus during Parturition — Rupture of the Posterior Pnrietes 
of the Faii^ina — Passage of the Foetus through the Rupture. — A woman, 27 years 
of age, was delivered at her full period, spontaneously but with much straining. 
The after-birth was also discharged with much pain; and, after the delivery of 
this last, the woman experienced acute pain in the vagina, and on applying her 

No. LI.— -May, 1840. 'ZO 


Progress of the Medical Sciences, 

hand to the part, she felt a round, smooth body in the vulva. Dr. Schnacken- 
BERG WHS sent for. and found the uterus was prolapsed through a rent in the 
posterior parietes of the vagina. He immediately set about replacing the organ. 
With his right hand well oiled, he endeavoured first to make the segment of 
the uterus re-enter through the fissure in the vagina, and afterwards to push it 
upwards with the hand applied flat on the wound. He supported for some 
time the perineum, and pressed it upwards with the base of the uterus which 
rested on it. Gradually the uterus rose up, and assumed its natural position. 
The patient was kept in a suitable position; the lochial discharge came on with- 
out difficulty, and the patient got entirely well. — Gaz, Med. de Farisy Oct. 5, 
1839, from Caspar's Wocheiischrift fur die gesarnrnte Heilkunde. 

40, On the Injluence of the Length of the First Stage rf Labour on the Duration 
of the Second^ and the Consequences to Mother and Child. — This question has lately 
been much discussed, and has given rise to quite a controversy between two of 
the highest authorities in obstetrics, Dr. Hamilton, of Edinburgh, and Dr. Col- 
lins, of Dublin. In a report of the Western Lying-in Hospital and Dispensary, 
Dublin, Dr. Fleetwood Churchill furnishes some statistical statements which 
afford valuable data towards the determination of that questif)n. 

He has taken, indiscriminately, 21 cases of labour of 36 hours' duration and 
upwards, and has marked down the duration of each stage, and the issue of the 
labour to the mother and child. The rupture of the membranes is taken as the 
limit of the first stage, and the intervals from the commencement of labour to the 
rupture of the membranes, and from the rupture of the membranes to the birth of 
the child are given. 

Nine cases of labour, of thirty-six hours' duration: 

No. of Cases. 

First Stage. 

Second Stage. 


Its to 


In 5 cases 

] premature 
1 case 

35 hours 




1 hour 


F.ivou ruble. 



jr cases of labour, of forty-eight hours' duration: 

No. of Cases. 

First Stnge. 

Second Stage. 



Its to 


In 1 case 


47 hours 


1 hour 




Stiii-biirn (funis 


Six cases of labour, of sixty hours' duration: 

No. of Cases. 

First Stage. 

Second Stage. 


ts to 


In 3 cases 

59 hours 

1 hour 



Three cases of labour, of ninety-six hours' duration: 


No. of Cases. 

In 1 case 

First Stage. 

95 hours 



Second St; 


1 hour 



Results to 
Mother. Child. 



This table appears quite conclusive of a fact which Dr. Churchill is desirous 
of establishing, viz: that the length of the period after the evacuation of the 
liquor aninii, bears no proportion to the tinne which elapsed previously, for out 
of 21 cases of labour, varying in duration from 36 to 96 hours, in only 4 did the 
second stacre amount to more than four hours, whilst in 1 1 it was concluded in 
one hour; neither did the duration of the second statje increase in proportion to 
the prolongation of the whole labour, for of the 3 cases of 96 hours each, in only 
one did the second stage exceed three hours. 

These series of facts so far as they extend, are in direct opposition to the 
opinions maintained by Prof. Hamilton; for a prolonged first stage neither ren- 
dered *'the powers of the uterus inadequate to expel the infant with safety to 
its life or to the future well-being of the patient," nor disposed the " uterus to 
contract irregularly, so as to occasion retention of the placenta," nor too feebly 
"to prevent latal hemorrhage;" nor, lastly, did it give rise to "febrile or inflam- 
matory affections of a most dangerous nature. "*" For, Jirst^ all the children 
were expelled alive, and continued to live, except two; one of which was pre- 
matiire (six months), and the other presented with the funis, and whose deaths 
were consequently not attributable to the protraction of the labour. Secondly^ 
neither flooding, retention of placenta, fever, nor inflammation, happened in any 
case; on the contrary, every one of the cases recovered as well as after an ordi- 
nary labour of twelve hours' duration. 

"The causes of the delay in these cases," says Dr. C, "were generally such 
as are enumerated in midwifery works, and with especial clearness by Dr. Ha- 
milton—premature evacuation of the "waters," rigidty of the soft parts, depres- 
sion of the anterior lip of the os uteri, &c., &c., and the treatment usually re- 
commended was employed successfully." 

41. Statistics of Labour.— V^e, extract also from the interesting report of Dr. 
Churchill the Ibllowing statistics: 

Number of females delivered under the care of the Western Lying-in Hospital 
and Dispensary, Dublin, 638; intern 215, extern 413, abortions o.*}, leaving 605 
cases of labour. 

616 children born— 340 males, 276 females, 11 cases of twins, 49 still-born 
or died soon after birth, 31 males, 18 females; of these 

6 were premature. 

breech presentations. 




crotchet cases. 
1 footling case with prolapsed funis. 
1 syphilitic. 

Ages of 534 women:- 

47 under 20 years. 
168 between 20 and 25 years. 
188 " 25 " 30 " 

* See Hamilton's Practical Observations, Part I. 

%B^ Progress of the Medical Sciences, 

67 between 30 and 35 years. 
59 " 35 '» 40 " 
5 " 40 " 50 " 

iDuration of labour in 513 cases: — 

Under 6 hours in 133. 

About 12 





















Interval between commencement of labour and rupture of membranes in 473 
cases: — 

Under 2 hours in 104 cases. 

About 6 





















































Interval between rupture of membranes and birth of child in 473 cases. 
Under 1 hour in 259 cases. 

















































Interval between birth of child and expulsion of placenta: — 
5 minutes in 145 cases. 









































Midwifery, 233 

From 1 to 2 hoars 18 cases. 

2 lo 3 " 


3 to 4 " 


5 hours 


6 " 


7 " 


Presentation in 582 cases:— 

In 545 It was natural. ] 

5 the hand descended with the head. 
14 the foot presented, 5 were lost. 
11 the breech, 4 were lost. 
4 the arm, 3 were lost. 
2 the funis, 2 were lost. 
1 the placenta. 

Six cases o^ turning (1 in 100). One child and all the mothers saved. 
One, furcepH case (I in 605). Mother and child recovered. 
Four crntchet cases (1 in 151). All the women recovered. 
Seven cases of hemorrhage. 
Four women died (1 in 151). 

42. On the Position of the Placenta in the Womh. — In our Number for May, 
1839. (p. 242,) we gave an analysis of an ino^enious paper by Mr. Carmichael, 
in which the author maintains th it in natural pregnancies, the placenta is always 
placed low down on the posterior wall, and that its being implanted in any 
other situation must ex necessitate during the growth of the uterus, or at least 
during its contractions to expel the foetus, cause a premature detachment and 
consequent hemorrhage. These propositions are controverted by Dr. Richard 
DoHKRrv ia an interesting paper in the Number of the Dublin Jour 7ial of Med. 
Science for July last. 

Dr. D. quotes several cases which seem to entirely overthrow Mr. Carmi- 
chael's theory. The most striking of these are the following: 

" 1. The first case I shall bring forward is one to which I was called on the 
5th of .Tune, 1838, in my capacity of Physician to St. Thomas's Dispensary. I 
was informed the woman v/as dying in consequence of loss of blood after deli- 
very. On my arrival, I found her pulseless, her features sunken, extremities 
cold, uterus lirge and hard. Having given her stimulants, and in vain tried by 
the usn\l means to cause the womh to expel the phcenti, I prepared to extract, 
and introducing my hand separated it with little difficulty from the low sr part 
of the anterior will. Its surface extensively presented that gritty degeneration, 
so frequently seen in such cases. On inquiry into the history of this patient, 1 
was informed by the midwife and other attendants, that her labour had been 
short and favourable, and no unnatural loss took place, until about half an hour 
after the birth of tiie child, which was alive and healthy. 

*' Here then is a case in which strong uterine contraction existed for four hours, 
without detaching the placenta, although it did not adhere to the posterior wall; 
but, as soon as the uterus had rested after the fatigue of labour, and established 
the peculiar action by which it throws off the after-birth, it succeeded in, at 
least partially, separalino- it, and hemorrhage ensued. Why, I would ask, were 
the strong expulsive eff'orts unable to effect as much, (particularly as so little 
assist mce was required to peel it from the uterus,) although this placenta was 
situ\ted where, it is asserted,. uterine action princip illy, nay almost exclusively, 
resides] I may add, that as soon as the after-birth was detached, the uterus 
acted naturally, and expelled both it and the h md together, yet 1 did not per- 
ceive any such partial or rotary contraction as is described. 

"11. Bridget Nicholson, aetat. 23, a plethoric countrywoman of rigid fibre, 
was almitted into the Lyin r-in Hospital, Ritland-square, on the 8th of De- 
cember, 1833, in labour of her second child. The pelvis was rather undersized 


234 Progress of the Medical Sciences, 

in its dimensions. For some time labour appeared to go on favourably, tboogh 
slowly; but after several hours had elapsed, and it was evident the head was 
not advancing in consequence of the want of a good tonic contraction of the 
uterus, borax was first tried, but this being found useless, three half drachm 
doses of ergot were administered with intervals of half an hour. The first two 
doses produced powerful uterine action, the last none. It was ultimately con- 
sidered necessary to resort to instrumental delivery. After the removal of the 
child, the uterus remained large and flat, by no means an uncommon sequel to 
the use of ergot. The placenta could not be moved by pressure, and at last it 
was requisite to pass the hand to detach it, which was accordingly done by Dr. 
Dwyer, the Senior Assistant Physician of the Hospital, who stated, it was placed 
on the anterior and upper part of the uterus. 

" Here then is an instance in which labour was prolonged for many hours, 
during a great part of which strong uterine efforts existed, nay even the uninter- 
rupted tonic contractions produced by ergot were called into action, and yet no 
hemorrhage occurred, no separation of the placenta was eflfected, although it 
was exposed to their violence, and placed in the very situation in which they 
are supposed by the author to be the strongest and'most efficacious, and where, 
to arrive at its then position, it must, according to his views, have undergone a 
considerable degree of rotation." 

" VI. The last case I shall cite is that of M^y Heron, setat. 24. pregnant for 
the third time, who was admitted into the hospital on the 13th of February last. 
Labour set in regularly on the following day, about nine o'clock, a. m. On 
examining this woman, I found the placental souffle distinct and sonorous, as if 
situated immediately under the stethoscope, in the right and upper angle of the 
uterine tumour. In the opposite angfle, the souffle could likewise be heard, but 
not at all so distinctly. It was also faintly audible across the fundus of the 
womb. In tracing it downwards from the right angle of the uterus, it gradually 
grew weaker, until, at last, it was entirely lost about an inch below the um- 
bilicus; — not the slightest murmur could be distinguished in either iliac fossa. 

"To these facts I not only directed the attention of several pupils, who hap- 
pened to be in the ward, but I also pointed them out to Dr. Herdman, the As- 
sistant Physician on duty, who satisfied himself of their correctness. Labour 
proceeded steadily from nine, a. m. till five, p, m., when the membranes rup- 
tured, and, in an hour after, the patient brought forth a living female child. 'I he 
placenta was expelled by a renewal of uterine action twenty-five minutes after- 

" If now we analyse this perfectly natural case, aqpording to Mr. CarmichaePs 
views, we should expect several circumstances to exist. In the first place, it 
would be reasonable to infer, as indeed was afterwards verified by examination 
of the secundines, that the sound indicative of the presence of the placenta, 
havinu been heard at the fundus, more plainly at the right angle and feebly at 
the left, that substance actually was affixed in the situation thus pointed out. 
And yet how cntrary is this to the author's assertion, that the placental mur- 
mur is never heard at the fundus, nor is the placenta ever situated there. Such 
being the case, then, in the second place it was to be supposed, that the uterine 
contractions would constringe the vessels, interrupt the function of the placenta, 
(and consequently destroy the life of the child,) and most probably detach it 
altogether, and that too 'very early in the process of parturition.' No such 
effigcts, however, were produced: the labour proceeded naturally, the infant was 
born alive, and no hemorrhage at any period took place. 

" But supposing that the uterus could contract in the way described, (namely, 
by the anterior wall shrinking within itself, and making the upper part of the 
posterior wall first become ihe fundus, and afterwards amalgamate itself with 
the anterior paries,) without producing the ill effects anticipated, still another 
objection, founded upon the foregoing case, may be urged against this theory. 
If the uterine contractions were thus effected, it should necessarily have hap- 
pened that the bruit, which was faintly heard across the fundus about an inch 
below its highest point, should gradually have mounted upwards; and, as labour 

Midwifery, 235 

proceeded, and that portion of the posterior wall, to which the placenta was 
attached, at last assumed an anterior position, it should have become hiuder and 
louder, until it developed itself in full intensity under the instrument placed in 
the centre of the uterine tumour below the fundus. And the situation of this 
distinct murmur should from that period have descended, accordinff as the capa- 
city of the uterus diminished, until at length it almost arrived at the pubis. 
This appears a fair deduction from the author's observations. But instead of 
such being the facts, I most explicitly declare, that no change whatever was 
observable in the pf»sition of the placental souffle, nor was there any alteration 
in its relative intensity in the region of the uterus. 

'* Again, if such a revolving movement took place, as the membranes re- 
mained uninjured, until the foetal head had been impelled deeply into the pelvis, 
I suspect the orifice, through which the child passed, should have shown, that 
at the time of their rupture, the placenta was situated on the anteriur wall. But 
on the contrary, the membranes at the anterior edge of the placental mass were 
rather longer than at the posterior edge, and the pouch formed for the fundus 
was somewhat anterior to that organ; thus pointing out its situation to have 
been, all through labour, the same as stethoscopic examination already proved 
it to be." 

From the foregoing cases Dr. D., thinks it obvious, that to avoid the early- 
separation of the [dacenta, and its attendant consequences, it is nut necessary 
that that substance should adhere to the back part of the uterus, or even to any 
region, in which contractions do not take place, save for the purpose of detaching 
its own connection. 

" But, furthermore," he maintains, " that no such contraction, as that for which 
Mr. Carmichael contends, could by any possibility be effected by such structures 
as, anatomy shows us, alone exist in the genital organs The only resemblance 
in the body to such a rotatory movement, is the pulley-like contraction of certain 
muscles, such as the digastric, the obliquus superior oculi, the circumflexus 
palali, &c. In all these, there are necessarly present, at least, one strong at- 
tachment to a bony structure, which, during the action of the muscle, acts as a 
fixed point, and a collar in which the muscle plays, and which serves to retain 
it in its proper place. Where then are we to find such an arrangement in con- 
nection with the generative organs] 

"The vagina, to which the uterus is attached below, during parturition, 
dilates and becomes more relaxed in its tissues, and could not act the part of 
such a firm bond of union; nor could any of the ligaments by which the womb 
is supported, but not fixed in its natural situation. Even the round ligaments 
which have been supposed, erroneously, 1 think, to perform the office of tendons 
to certain of the uterine fiibres, do not take a direction that would enable them to 
be of any service in the newly proposed action. On the contrary, the uterine 
contraction must, by bringing their points of attachment nearer to each other, 
prevent them from giving any fixity to the organ. W here then are we lo seek 
the point around which the fundus turns, and without which, such a partial con- 
traction of the uterus must, instead of producing a revolving movement in that 
pa.t, draw it directly downwards, and cause the convex fundus to assume a flat- 
tened form? 

" The author attempts to supply this deficiency, by assigning to the foetal 
body the office of a fulcrum. 1 am not prepared to deny that such perhaps 
might be the case, if the remainder of his theory were correct; but 1 would in- 
quire, what fulcrum can there be, where the uterus, having expelled the child, 
again 'relaxes completely,' as in the case which that author brings forward, as 
the fifth instance where he found the placenta on the posterior wall ? What 
prevents us in such a case, when causing contraction by external pressure or 
the application of cold, from feeling the fundus grow flat under our hand. How- 
is the rounded prominent appearance of the fundus maintained] 

"Such are the considerations which, to my mind, throw a doubt upon the 
validity of the theory proposed by Mr. Carmichael. The subject of the contrac- 
tion of the uterus, and the mode in which the placenta maiutains its adhesions 


236 Progress of the Medical Sciences. 

undisturbed, and its functions iinextingfuished, during^ the uterine efforts, are 
certainly involved in jrreat nbscuriiy, and the explanation offered by that g-enlle- 
man (obviously the result of deep thoujrht and extensive research on this curious 
subject) carries with it such apparent truth, that it de^^ervtdly excited great at- 
tention in tlie profession But I trust I have demonstrated the incorrecli.ess of 
his premises, and the fallaciousness of h\< conclusions, with r«'specl to these 
points. If I have succeeded in doingr so, I need scarcely allude to his theory 
of the development of the uterus. If the assumed moile of contraction bn not 
the true one, then there is no necessity for imagining its growth to be confined 
almost entirely to the anterior wall. The old doctrine, indeed, that all the parts 
of the womb enlarge, holding the same relative position to each other, but being 
allowed a certain latitude in the deirree and period of their expansion, affords, I 
think, a much more ready solution of well known facts connected with gesta- 
tion. It accords wMth the dilferent forms the uterus assumes at the several 
stages of pregnancy; its being first pyriform, then oval in consequence of the 
increase of its transverse diameter at its central and lower part, and becoming 
at last ijlobular when the cervix has also dilated. It explains too the phenomena 
observable in placental presentations, in which the hemorrhage, consequent on 
expansion of ilie uterine parietes, occurring where the placenta has not tht; power 
of accommodating itself to the change, in general takes place almost entirely in 
the three last month-s." 

43. Case of complete Detachment of the Os Uteri. By Hugh C armichael. Esq — 
*' Late one evening in the course of last autumn, I was requested to visit a young 
unmarried female, who, I was informed, was about to be confined of her first child. 
On my arrival 1 learned that about an hour previous to my being sent for, she 
was from home, and when at some distance from it, the waters, as it is termed, 
broke, and that belore she could reach her residence they had been almost all 
discharged. On making an examination, I found the os uteri sufficiently dila- 
ted to adiuit the point of my finger, butthinand hard; the pains slight, but re-jru- 
lar. 8he continued in this state the entire of the next day, the following night, 
and a part of the ensuing day; the pains at no time increasing beyond those of 
the first stage of parturition. During this pt-riod, though the pains were insuf- 
ficient, nevertheless, the head progressed, the os dilating but very slowly, until 
the dilatation became about the size of a crown piece, beyond which it did not 
extend, its edyes still continuing hard and rimmy. There was no deformity of 
the pelvis. Considering that the obstinacy which the os exhibited might pro- 
bably result from the insufficiency of the pains, I determined oh inducing them, 
if possible, to a certain extent, and with that view, on the second day, admin- 
istered the ergot of rye in such doses as to throw the uteru-j rather upon the 
tension, than induce the strong uterine contractions that follow its full doses: I 
gave five grains of the ergot, and in about ten minutes afterwards evidently per- 
t;eived the uterus slightly ergotised. Considering the obstinacy of the os, I 
contented myself with carefully watching the continuation of the action of the 
ergot upon the uterus, and when it began to abate, repealed it in the same dose; 
this interval was in or about half an hour In this way three doses of the 
ergot were given, and although I had the uterus so ergotised, that under ordi- 
nary circumstances, the os must have given way, (dilated), it still continued to 
resist the contractions of that viscus. 1 should have observed, that by this lime, 
in consequence of the very protracted state of ihe labour, the patient had been 
much exhausted, so that interference was evidently called for. It may be said 
that bleeding, tartar emetic, and other relaxants should have been tried; 1 can 
only say I gave them the fullest consideration, and determined on the ergot in 
the way administered in preference; and I would here submit, that there are 
peculiarities attending sometimes particular cases, so dev'ious from what are 
usually to he observed, that the treatment must be modified accordingly, in proof 
of which 1 believe I could not refer to any one more competent to give judg- 
ment on than yourself from the very extensive practice afforded at the Coonn'o 
Lying-in Hospital. However, to resume, the os did not yield, but the head 


Midwifery, 237 

was propelled fully into the pelvis, pushing the cervix before it. In the course 
of the evening of the second day the patient's condition grew worse; she be- 
came delirious, the pulse quick and irregular; and in a word, she must have 
quickly sunk if interference had not been resorted to. To apply the forceps, 
1 can only say, the circumstances of the case were such as decidedly to pre- 
clude it; there was nothing therefore but the crotchet, and with the hope, though 
possibly a faint one, of being able so to break up and dismember the child, as to 
transmit it through the os, the perforator was resorted to, and the cranium evacu- 
ated of its contents; the crotchet was then introduced, and traction of a very 
gentle nature made on one of the parietal bones, for the purpose, if possible, of 
detaching it, in order to my intention as above stated. During this, however, 
a strongcontractionof the uterus succeeded, when the head was at once expelled, 
carrying before it the os and a part of the cervix of the womb, the diameter of 
which measured about three inches and a half, which preparation is in the mu- 
seum of the Coombe. The placenta came away in the usual manner, there 
was, however, considerable hemorrhage, and such difficulty in getting the womb 
to contract, that the cold affusion became necessary. Two hours after the deli- 
very I became much alarmed for my patient; jactitation, restlessness, difficulty 
of breathing, &c. I gave her a full anodyne, and having procured tranquillity, 
and given all the necessary instructions to a competent person as to the state 
of the uterus, which was padded, and other parts to be attended to, left her for 
the night. On my visit the next morning— and 1 confess to you it was not with- 
out strong apprehensions that I should have found her either dead or dying — to 
my surprise, she was sitting up in the bed eating her breakfast, expressing how 
comfortable her condition was compared with of the preceding day. 

"The remaining part of this case is very short, she recovered without a sin- 
gle bad symptom, and in the usual time. I have had an opportunity several 
times since of seeing this young woman, and of making an examination of the 
parts; the present artificial os is in the usual place, in the upper and anterior 
part of the vagina, of a pursed up or puckered appearance or feel; she menstru- 
ates, but irregularly, and most profusely, accompanied with large clots of co- 
agula; and the case being extraordinary, 1 was induced to make inquiries from 
her with respect to sexual desires, which she informs me are nearly, if not 
entirely gone. She has never since proved pregnant. Such are the particu- 
lars of this curious case, and if 1 learn any thing of interest connected with it 
hereafter, 1 will gladly communicate it to you." 

Mr. Power, in some remarks which he offers relative to the above case, states 
that the timely incision of the os uteri, under similar circumstances, would, he 
is sure, be attended with as favourable a result and much less suffering to the 
mother, and perhaps with safety to the child. — Dublin Journal of Med. iScience^ 
Sept. 1839. 

On Incision of the Os Uteri in cases of incarcerated Placenta. By R. F. Pow- 
er, one of the surgeons to the Coombe Lying-in Hospital. — It sometimes hap- 
pens that the placenta is separated from the uterine parietes, but is confined 
within its cavity, in consequence of the os being fir m/y and rigidly contracted. 
This state is what is termed incarcerated placenta, and differs from the ordinary 
forms of irregular contraction of the uterus, in the contiaction being more limi- 
ted to the OS and cervix. Many causes may produce this unfavourable state, 
but which fortunately is not very frequent. I recollect but two cases occurring 
since my appointment to this hospital: they were extern patients, and had been 
attended by midivives^ and both were fatal. My friend, Mr. Armstrong, told 
me of another, that he had been called to lately in this city. The result of 
these cases is most generally fatal, the patient dying from the effects of a 
typhoid fever, probably excited by the putrescent mass retained in the system. 
When a portion of the placenta only is retained, a purulent discharge conse- 
quent upon inflammation is sometimes secreted, by the living membrane of the 
uterus, and by which the particles of the intruding body are carried off. It is 
^Iso recorded that the placenta has been altogether removed by absorption; such 


238 Progress of the Medical Sciences, 

cases are however extremely rare, and are essentially different from those now 
un<ler consideration, in which the general termination is death. The first of 
these complications that came under my notice, was in a poor woman living in 
Engine-alley, and occurred shortly alter 1 commenced my attendance here; it 
was produced hy the improper conduct of a midwife who broke the /un/s, in her 
efforts to extract the placenta, and probably thus irritated the os. The cord 
was ruptured close to its placental attachment, the os was not comp etely closed 
but grasped tighllt/ a small portion of the placenta, which filled it like a plug; it 
resisted all the means that were adopted for its relaxation. I was favoured in 
the treatment of the case by the advice and assistance of my friends l)rs. Breen, 
Halahan, and Carmichael, men whose high professional characters are a suffi- 
cient guarantee, that all the ordinary and approved methods of treatment had 
been resorted to, and they tried them, but to no purpose, the patient died in a 
few days. The second instance was nearly similar. In both of these cases 
the women had arrived at the full period of gestation, to which state these 
remarks only apply. 

In reflecting afterwards upon the case of the poor woman in Engine-alley, 
and which was particularly unfortunate, as she left a large young family of 
helpless orphans, the thought often flashed across my mind; that a simple inci- 
sion of the OS, would have enabled us to have taken a sufficient hold of the pla- 
centa to withdraw it. The os was fully within reach, and I would say, that, 
at least in this instance, the operation was practicable. I am well aware there 
would be greater difficulties attending it here, than in the instance already allu- 
ded to; there is no doubt a greater depth of parts to be encountered, but it will 
be recollected I am speaking of cases where death is, I may say, inevitable; 
when the organ has receded, and its contractions have extended beyond the 
lower portions, then of course this operation would be out of the question, but 
1 beg to be understood as referring only to instances in which the rigid contrac- 
tion is litnited to the os, and perhaps a portion of the cervix, a state which is 
readily discernible, and two examples of which, as before mentioned, came 
under my own observation. In such, after a,l the ordinary means have been tried 
in vain, and death seems certain, as a last resource, before the powers of life 
were too far exhausted, would this operation be admissible'? Are there any cir- 
cumstances that would render the after consequences of it, in this instance, 
much more dangerous than in the others] In premaiure labours, w'len the after- 
birth has been lonu retained, or where a portion of that body has been left in 
the uterus, and alarming febrile symptoms supervene; upon its being cast off, or 
removed, the fever abates and the patient recovers. Now in the case I have 
alluded to, the placenta thrown off from the parietes of the womb, but confned 
in it by the contraction of the os, becomes putrescent, thus acts as a foreign 
body and lights up a typhus fever, which, unless the exciting cause he removed, 
will desuoy the patient; here, when all the approved agents fail in procuring 
its removal, or abating the distress, ere it be too late, would it be justifiable 
to simply incise the os, so as to enable the operator to get at and remove the 
immediate cause of the patient's suffering and danger] 1 merely throw out the 
suggestion, without pledging myself to it, in the hope that practical men will 
calmly consider it, and if in an extreme case it should ev^er be the means of 
saving a mother's life, my only object will be fully attained. 

Mr. Power gives the following directions for the performance of this 
operation. The patient should be placed on her left side, close to the 
edge of the bed, as in the ordinary obstetric position, the fore-finger of the 
left hand should be then carried to that part of the os or cervix intended 
to be cut, and a probe-pointed knife or bistoury conveyed cautiously along the 
finger in the vagina to the point mentioned, at which the os or cervix may be 
divided. This is done by gently insinuating the point of the instrument within 
the os, and pressing its cutting edge against the rim on each side, in the direc- 
tion in which it is intended to be incised, the parts will give way readily before 
it; and then cautiously giving the blade a withdrawing motion, the openings 
may be enlarged as much as may be deemed advisable. The bladder should be 

Medical Jurisprudence and Toxicology. 239 

previously emptied, and if the incision be brousrht forwards great care should 
be taken to avoid its neck. The liquor aninii will escape after the first incision, 
and if the uterus act, the case may then be lelt to nattire. Some tearing may 
take place during the passage of the head, but it is generally slight and con- 
fined within the limits of the vagina. (Ashvvell.) With a view of better 
avoiding laceration, a crucial incision of the parts has been advised. Before 
attempting this operation a very careful examination should be made of the os; 
for 1 recollect, on two occasions in this hospital, feeling a strong pulsation in 
the OS, as if a large vessel coursed along a part of its rim. Indeed on the first 
occasion I imagined it w s the funis that caused this pulsation, and it was not 
until after a careful examination, thnt 1 was satisfied as to its true source. 
There is seldom much blood lost, hi Dr. Ashwell's and Mr. Tweedie's cases 
only a few drachms escaped, and the hemorrhage which followed in Mr. Hugh 
Carmichael's case can not be said to have been altogether derived from the torn 
parts. If nowever the section of the parts be succeeded by a prol'use hemorrhage; 
*or in the event of its being so long delayed that it might be highly improba- 
ble that the uterus would be competent to resume its office, or finally to effect 
its own delivery, then it should become a matter of deliberation with the prac- 
titioner, whether he should further assist by having recourse to the use of the 
forceps, or to the manual operation of delivering by the feet. As a general 
principle, it can not be denied that the hand, being of softer texture, and itself 
endowed with feeling, would be the more gentle instrument; on the contrary, if 
we suppose the fueial head considerably advanced, or deeply engaged in the 
cavity of the pelvis, and a suffici«;nt extent of communication to have been 
made between the uterus and the vagina, it is evident that the application of 
the forceps might prove a much preferable measure.'* If there should be 
fainting and collapse after the incision, stimulants, such as brandy and ammo- 
nia, may be freely given." Dublin Journal Med. Science^ Sept. 1831). 


45. Poisoning with Nitrate if Silver^ cured by soluiion of Common Salt. — A very 
interesting case of this recently occurred at the Hopital Saint-Louis. The 
patient, a man ap.tat. 21, staled after his recovery, that he had swallowed, an 
ounce of the nitrate of silver in solution. This quantity was probably exagge- 
rated, nevertheless he must have swallowed a large quantity from the extreme 
violence of the effects, and the matters which the patient vomited 12 or 18 hours 
afterwards blackened the sheets and currains of the bed, wherever it touched 
them. When brought to the hospital, June 23, the patient was insensible and 
there was insensibility of every part of the body; convulsive movements of the 
face and upper limbs; jaws firmly closed; eyes rolled up; pupils dilated and 
insensible to light. A solution of salt and water was freely given. After the 
lapse of an hour and a half, the pupils became less dilated, and the convulsions 
and closure of the jaws cea.sed. The salt water was continu.jd for eight hours, 
when emollient drinks were substituted. At this period the insensibility was 
less profound, and the patient s.iffered from violent pains in the epigastrium. 
It was not, however, until eleven hours after his entrance that the general sen- 
sibility returned and the patient was able to speak. Some hoars afterwards, 
profound coma, with insensibility returned and continued for two hours; and 
the next day, and the day after he had a similar attack. After this, convales- 
cence proceeded uninterruptedly, and he was discharged well, June 2yth, Bulletin 
Generate de Therap. Sept. 1839. 

46. Deaths by Poison. — A very interesting report made to the House of Com- 
mons at the instance of Sir Robert Inglis, has recently been published. It is enti- 

• Davis^s Operative Midwifery, page 98, 

240 Progress of the Medical Sciences, 

titled "Returns from the Coroners of England and Wales of all Inquisitions held 
by them during the years 1837 and 1838, in cases where death was found, by ver- 
dict of Jury, to have been caused by poison." These returns it must be pre- 
mised are not complete, some coroners having neglected to comply, with the 
request of the Commons, and those who have complied having in many instances 
omitted particulars of great moment; notwiihstandinsr these inperfections, the 
document is valuable, and the puplic not only of England, but of this country 
\t'ould be benefitted by its extended publication. We can give, only, a summary 
of the more interesting points. 

The total number of deaths by poison, 1837-38 was 543, of which 261 were 
females, and 282 males. 

The total number of individuals poisoned by opium, or its preparations, was 186. 

The deaths of very young children (most of them at the breast), from opium, 
or its preparations, administered by mothers and nurses, in ignorance of the 
powerful effects of those substances on infants, were 52 

The deaths of young children from opium 'T laudanum administered in mis- 
take for other medicine, were 20. In 11 of these cases, the names of the medi- 
cines are given, in the place of which opiates were given by mistake. 

The very great number of deaths amongst children, resulting from overdoses 
of opium, or its preparations, and from doses thereof given in mistake for other 
medicines, cannot fail to excite attention. Deaths of this kind amount nearly 
to a seventh of the entire number of deaths by poison. The number was 72! 

Most of the children poisoned in this way lost their lives owing to the ijrno- 
rance, carelessness, or presumption o^ their mothers. It cannot be too generally 
known that narcotic and anodyne drugs, powerful though they be in the adult, 
act with infinitely greater energy upon the more sensitive nervous system of the 
infant; so that even experienced medical men never administer remedies of this 
class to the very young, without exerting the utmost caution and making the most 
accurate calculation. Two drops of laudanum have been known to kill an 
infant, nay, we heard of a case in which one drop stole away the life of a new 
born babe. It is evident that the practical inference to be deduced from the 
facts represented in the above table is— that mothers and nurses should never dare 
to administer medicines of the0iarcotie kind, except under the immediate direction of 
the medical attendant. 

The Coroner of Nottingham states, that "Godfrey's Cordial is given to chil- 
dren to a great extent; and that he has no doubt whatever, that many infants are 
yearly destroyed in that borough*, but who, dying off gradually, never come 
under his notice officially." There can be no doubt of the truth of this asser- 
tion. At all events we can say positively that such instances occur elsewhere. 
Land, Med. Gaz. Nov. 1839. 

47. Excoriation round the Throat of a still-born Infant. — Dr. E. Kennedy exhib- 
ited to the Dublin Obstetrical Society, a still-born infant, with excoriation round 
the throat, of a dark red colour, and remarked how easily such a circumstance 
might be mistaken for the result of violence, were it not for the appearances 
presented by the chord. 


4^. Sugar in the Blood and Urine of Diabetic Patients. — It is stated in the 
Journal de Chimie Medicate for Dec. 1839, that M. Muller, of Medebach, has 
succeeded in detecting sugar in the blood of a diabetic patient. From 12 ozs, 
of that fluid he obtained 1 drachm, 5 grs. of sugar; and from 50 ounces of urine 
from the same subject, he obtained as much as 2 ozs. 3 drachms and 37 grs. 

49. On the Composition of Milk. — M. Donne considers milk to consist of a 
fiuid holding in solution caseum, a particular variety of sugar and salts, and in 

Miscellaneous. 241 

a state of suspension globules of fatty matter or butter. Alcohol and ether dis- 
solve the fatty or milky globules, but have no action on the caseum. A watery 
solution of iodine colours the caseum yellow, but has no action on the milky 
globules. These facts prove that the caseum forms no part of the milky glo- 
bules, and that it does not exist in a concrete form in the milk. 

All the milky globules are retained by the filter, and the liquid which passes, 
through it is transparent as water, and deposits the caseum on the addition of 
an acid. This fact proves that the caseum is in a state of solution, and also 
that the white colour of the milk is owing to the presence of the milky or fatty 
globules which are suspended in it. Milk may, therefore, be considered as an 

When milk is allowed to stand, the cream ascends to the surface. The 
caseum is only the separation of the milky globules on account of their lighter 
specific gravity; and if the milk be examined in a transparent vessel, it will be 
seen that the layer next the cream is the whitest, whilst that at the bottom of 
the vessel is of a greenish hue, and semitransparent. This difference of hue 
is owing to the greater or lesser proportion of milky globules in the diflferent 
parts of the fluid. 

When it is allowed to stand some time longer it becomes acid, though it was 
alkaline when first drawn. The cream gradually thickens, the caseum becomes 
consolidated, gaseous matters are disengaged, a strong odour of rotten cheese is 
perceived, and the microscope discovers a multitude of animalcules and infusory 
vegetables. If the milky globules be previously separated, they are found to 
become rapidly acid; whilst the watery portions holding in solution the caseum 
undergo the alkaline or putrefactive decomposition. 

The infusory vegetables in milk are not observable till long after it has un- 
dergone the acid change. It cannot, therefore, be considered as the cause of the 
acetous fermentation, as is remarked in vegetable infusions, which undergo the 
alcoholic fermentation. The infusory animalcules exist equally in the acid as 
in the alkaline part of the milk during these changes. 

M. Donne has remarked, that there is a fixed relation between the secretion 
of the colostrum in the breast before delivery, and the secretion of the milk after 
that process; and he thinks that women may be in this respect divided into three 
classes. T\\e first class includes those in whom there is scarcely any milky se- 
cretion till delivery is over. In them the colostrum consists of a viscous liquid 
containing a very few milky globules mixed with granular bodies. In these 
circumstances the milk after delivery is always poor, and in small quantity. 
In the second class the colostrum is more or less abundant, but is poor in milky 
globules, which are small and ill-formed. Besides the granular bodies, mucous 
globules are detected in the colostrum. After delivery, the milk is more or less 
abundant, but is poor and serous. In the third class, the colostrum is rich in 
regularly-formed milky globules, and is only mixed with the usual granular 
bodies. The milk which is secreted after delivery is abundant, rich, and of 
good quality. It is this class of women who ought always to be preferred as 
nurses. — Ed. M. and S. Journ. from Compte Rendu de PJlcad. des Set., Sept. 1839. 


50. Sir James Clark's Statement of the Case of the late Lady Flora Hastings. — 
So long as the accusations brought against me, in reference to the case of the 
late Lady Flora Hastings, continued to be either anonymous or unauthorised, I 
felt it right to submit in silence to every species of provocation, rather than bring 
before the public circumstances of a very delicate nature, which came within my 
knowledge in the implied confidence of professional intercourse. The publica- 
tion, however, of the Marquis of Hastings, the nearest relative of Lady Flora 
Hastings, made me doubt seriously whether, in regard to myself, as well as the 
profession, I was justified in not laying before the public an account of the case 
No. LL— May, 1840. 21 

242 Progress of the Medical Sciences. 

so far as I was concerned. The renewed attacks which have followed that pub- 
lication permit me no longer to hesitate; although, even now, it is with the ut- 
most reluctance I bring myself to enter into details which, I am of opinion, 
ought never to have been made the subject of public discussion. 

On the 10th of January last, 1 was consulted by Lady Flora Hastings, who 
had that day arrived from Scotland, and had come into waiting on Her Royal 
Highness the Duchess of Kent. She had derangement of the bowels, and of 
the general health, and she complained of pain low in the left side. There was 
also considerable enlargement of the lower part of the abdomen. 

Under the use of some very simple remedies the derangement of the bowels 
and the pain in the side gradually abated, and ultimately ceased; and Lady 
Flora complained only of weakness. 

The size of the abdomen, however, continued undiminished; and Lady Flora's 
appearance became the subject of remark in the palace. About the 1st of Feb- 
ruary, as neerly as I am able to fix the date, 1 was sent for by Lord Melbourne; 
and, on going to him, his Lordship informed me that a communication had been 
made to him by Lady Tavistock, respecting Lady Flora Hastings, whose ap- 
pearance had given rise to a suspicion in the palace that she might be privately 
married: his lordship asked my opmion on the subject. I stated, in reply, that 
while 1 thought such suspicions ought not to be readily listened to, I was, at the 
same time, bound to admit to him that the appearance of Lady Flora in some 
degree countenanced them. 1 added that, without more ample means of obser- 
vation, 1 could not venture to give an opinion on the subject; and his lordship 
agreed with me that no step should then be taken in the matter. 

From this time the condition of Lady Flora Hastings caused me considerable 
anxiety. The only source, besides pregnancy, from which the size and peculiar 
form of the abdomen could proceed was disease; but the probability of disease 
being the sole cause, in Lady Flora's case, was diminished by the circumstance 
that the enlargement was accompanied by very little general derangement of 
health. In fact, Lady Flora continued to perform her usual duties with appa- 
rently little inconvenience to herself. 

I continued to visit Lady Flora about twice a week, from the 10th of January 
to the 16th of February, and on several occasions examined the state of the ab- 
domen over her dress; but being unable, in this M^ay, to satisfy myself as to the 
nature of the enlargement, I, at length, expressed to her my uneasiness respect- 
ing her size, and requested that, at my next visit, 1 might be permitted to lay 
my hand upon her abdomen with her stays removed. To this Lady Flora de- 
clined to accede. 

Matters remained in this state until the 16th February. On that day I found 
it had been determined that I should acquaint Lady Flora with the suspicions 
which existed in the palace, and should suggest her calling another physician 
into consultation with me. Before visiting Lady Flora, 1 asked Lady Portman, 
the lady in waiting, if I might use her name to Lady Flora, as one of the -ladies 
who entertained the suspicion respecting her. To this. Lady Portman at once 
assented. Her Ladyship then described the peculiarities in Lady Flora's form 
and carriage, which had produced the impression in regard to her state. To the 
question as to what my opinion on the subject was, 1 replied that the appearances 
were certainly suspicious, but that even to medical men such appearances were 
often deceptive. Lady Portman concluded by observing, that for the sake of 
Lady Flora Hastings herself, as well as of the court, it was necessary that the 
matter should be cleared up. Immediately after this interview with Lady Port- 
man, I went to Lady Flora for the purpose of making to her this very unpleasant 
communication; and I need hardly add that 1 made it in the most delicate terms 
which I could employ. After a few remarks on the state of her health, I told 
her that her size had attracted the attention of the ladies, and that it was now 
my painful duty to acquaint her ladyship that they had, in consequence, been 
led to suspect that she must be privately married. This was the mode, and 
these were the words in which the painful communication was made. 
I urged Lady Flora, for obvious reasons, if there were grounds for this sus- 

Miscellaneous. 243 

picion, to acknowledge the fact, and if not, to see another physician at once, to 
put an end to the rumour. Lady Flora denied that there were any grounds what- 
ever for the suspicion, and named Sir Charles Clark, who, she said, had known 
her from her childhood, as the physician she would wish to be called in; but 
she declined, notwithstanding my earnest entreaties, to see him on that day. 
This refusal, after the reasons which I had given, lessened very considerably 
the effect upon my mind of her ladyship's denial. 

After the interview with Lady Flora it remained for me to communicate what 
had passed to her royal highness the Duchess of Kent. I, therefore, informed 
Lady Flora that I was going to her royal highness for that purpose; to the 
propriety of this Lady Flora immediately assented. I accordingly went to the 
Duchess of Kent, and stated the nature of the interview I had had with Lady 
Flora. Her Royal Highness immediately expressed her entire disbelief of any- 
thing injurious to Lady Flora's character, and she asked me my opinion. How- 
ever reluctant I felt to express any doubts on the subject after Lady Flora's de- 
claration, I could not decline giving a conscientious reply to her royal high- 
ness's question; and I answered to the effect that the suspicions 1 previously 
entertained were not removed. 

In the course of the evening of the day on which I made the communication 
to Lady Flora Hastings, I received a note from her ladyship, of which the fol- 
lowing is a copy: 

" Saturday. 

*' Sir — Although I think you perfectly understood me this morning, that f did 
not wish you to take any steps without hearing from me, it is perhaps better, to 
obviate the possibility of any mistake, that I should distinctly say so. I shall 
be governed entirely by her royal highness's wishes and orders. 

"Yours sincerely, Flora Eliz. Hastings." 

I heard nothing more on the subject till the afternoon of the following day, 
(Sunday, February 17th,) when I received another note from Lady Flora, of 
which the following is a copy: 

"Sir — By her royal highness's command I have written to ask Sir Charles 
Clarke to name an hour this afternoon to come to me. He has answered my 
note by coming, and is now here. Could you come and meet him? 

" Yours sincerely, F. E. Hastings." 

On receiving this note I immediately went to Lady Flora, and found Sir 
Charles Clarke with her ladyship. He stated to me, in Lady Flora's pre- 
sence, as part of the conversation he had had with her, that he urged her, if 
there were any grounds for the suspicions entertained, to admit the fact now, as 
after the examination it would be too late. 

After this conversation. Lady Flora requested that Lady Portman might be 
called in. On her arrival. Lady Flora retired to her chamber, where her maid 
was in attendance. After Sir Charles Clarke had made an examination, he re- 
turned with me to the sitting-room, and stated as the result, that there could be 
no pregnancy; but at the same time he expressed a wish that I also should 
make an examination. This I at first declined, stating it to be unnecessary; 
but, on his earnestly urging me to do so, I felt that a further refusal might be 
construed into a desire to shrink from a share of the responsibility, and I accord- 
i'^g^y yielded. After finally consulting, we gave the following certificate. 

{Copy (if Certificate.) 

" Buckingham Palace, Fehruary 17, 1839. 

" We have examined with great care the state of Lady Flora Hastings, with 
a view to determine the existence or non-existence of pregnancy, and it is our 
opinion, although there is an enlargement of the stomach, that there are no 
grounds for suspicion that pregnancy does exist, or ever did exist. 

(Signed,) " Charles M. Clarke, M. D. 

"James Clarke, M. D." 

Before parting with Lady Flora, both Sir Charles Clarke and myself pressed 
upon her ladyship the expediency of her appearing on that day at table as usual. 

Such is a plain statement of the leading facts of this unfortunate case,- so far 

244 Progress of the Medical Sciences. 

as I am concerned. That I was unable to ascertain the true nature of Lady 
Flora's state, 1 at once admit, and most deeply regret: but when the difficulties 
which frequently occur in cases of this description, even where every facility is 
afforded for investig-ation, are considered, it can scarcely be made a matter of 
reproach to me that, amidst the disadvantages under which I laboured, I was 
unable to affirm that Lady Flora's change of appearance was the result of 
disease, and of disease alone. If even Sir Charles Clarke did not venture to 
express a positive opinion until after a careful examination, it will be readily 
conceded that no other person could have done so without recurring to spme 
similar proceeding. And if any thing further were required to establish the 
difficulties of this very peculiar case, and the heavy responsibility attaching to 
a decision on it. Sir Charles Clarke knows that there are other facts connected 
with it which prove, in the most unequivocal manner, both the one and the 
other — facts which do not throw the slightest shade of doubt on the purity of 
Lady Flora, nor are matter of blame to any one, but which it is not necessary to 
bring before the public. 

The post-mortem examination established the fact, that the death of Lady 
Flora Hastings was occasioned by extensive disease, dating its origin " at some 
former and distant period of time;" and yet such was the obscurity of the symp- 
toms which, during life, accompanied the disease, that its nature became evident 
a few weeks only before Lady Flora's death; and the fact of its having involved 
every organ within the abdomen was revealed only on the post-mortem exami- 

I think it right to notice, in this place, a part of m)'^ conduct which may at 
first sight appear censurable. I allude to the admission of my suspicion, that 
Lady Flora might be pregnant, before I had been permitted more fully to 
examine into her state. Under almost any other circumstances it would have 
been highly improper for me to have answered an inquiry on such a subject; 
but as I could not authoritatively remove suspicions founded upon appearances, 
which, taken alone, would, in a great majority of cases, indicate what was feared 
and not the singular state of disease revealed after the death of Lady Flora, I 
felt it my duty, considering the very peculiar responsibility which attached to 
me, to confide the doubt which was in my own mind to those who had a right 
to demand my real opinion, and who, I felt assured, could not use it in a manner 
unfriendly to Lady Flora. 

[We have inserted the preceding statement, as the event which it records 
has excited great attention, and to gratify some of our correspondents who 
have requested information relative to it. That this occurrence should have 
ever been made public is one of the evil fruits of the virulent party spirit of 
the present times. It was seized on by a party, who, for the promotion of 
political purposes, have not hesitated to invade the sanctities of private life, 
outrage female delicacy, and expose to public gaze a circumstance which should 
never have been known beyond the precincts of the palace. Whilst every one 
must have felt the deepest sympathy for the unfortunate position of Lady Flora, 
it must be admitted to have been necessary for the moral character of the court 
of the youthful Queen, that suspicion should be set entirely at rest respecting 
the condition of an unmarried lady whose appearance led the ladies of the court 
to suspect that she was pregnant. 

That a physician officially called upon, under such circumstances, should, 
merely on the faith of the high character of the lady, the only certain means of 
ascertaining her condition being denied him, decline to testify to her not being 
pregnant, is what might have been expected; indeed, is the only course which a 
proper prudence and regard for his own character would justify. Sir James 
Clarke's statement is, in fact, the most thorough vindication of his own course 
in this unfortunate transaction. This distinguished physician is well known 
in this country by his writings, and is highly respected for the soundness of his 
views, and the extent of his acquirements; and his professional and private 
character, by the concurrent testimony of all who enjoy his acquaintance, stand 
on the loftiest eminence.] 




Case of Imperfect Vision, following a blow on the Eye. — Absence of the 
Crystalline Lens ascertained by Catoptric examination. By James 
W. Keril, M. D., one of the Resident Physicians to the Philadelphia 
Hospital, Blockley. 

Having observed in your Journal of August last a case illustrative of 
the " value of the catoptric examination of the eye as a means of diag- 
nosis," I have thought that a case confirmatory of the same fact might be 
interesting to you. The following case, which occurred under my obser- 
vation, is therefore presented to you for your disposal. 

J. M., a stone-cutter, while engaged at his trade in trimming a stone, 
18 years ago, was struck in the left eye by a piece of the stone, or of the 
instrument which he was using, which caused severe pain, redness and 
swelling. These were removed in a month by bleedrno", leeches and pur- 
gatives, but he has since been deprived of useful vision with that eye. 

The eye presents the following appearances:— Cornea, conjunctiva, 
sclerotica, natural; colour of iris same as that of the right; pupil black, 
clear, somewhat larger than the right; slightly irregular, apparently no ad- 
hesions; iris tremulous and somewhat contractile. Says that he can dis- 
tinguish day from night, and bodies when moved in front of the eye, and 
can see best from the nasal side of the eye. 

On examination with a lighted candle, I could only distinguish the first 
upright image from the cornea. I examined the eye several times, and 
could never see more than the one image. As this corresponded with the 
appearance of the eye in your case, I presumed that the lens had been dis- 
placed by the blow which he had received eighteen years ago. 

I then procured a pair of spectacles with double convex leirs, and ad- 
justing them to the eye, and closing the right one, he was much surprised 
at being able to distinguish objects. After wearing them for a few mo- 
ments he could readily distinguish a key, knife, cent, quarter or half dol- 
lar. I then directed him to wear them for a few hours, when he was able 
to distinguish persons and large letters. 

Although this case is not so satisfactory as yours, yet it is useful as 
showing the value of the catoptric examination as a means of diagnosis, 
and points out a ready mode of relief. 

Violent Symptoms from the Bite of a Rat. By Whitman Wilcox, 
M. D. of Baton Rouge, La., late Demonstrator of Anatomy in the Medical 
College of Louisiana. 

Benj. Bryan, aetat. 40,of good habits and constitution, received a bite from 
a rat upon the fleshy part of the hand, near the root of the thumb, about 
the first of March. Very litde notice was taken of the wound until 12 or 
13 days afterwards, when it commenced to be painful and tumefied. I was 
called in on the evening of the 17th, and found him with pain in the back 
and head, heat of skin, thirst, tongue with a thin white coat, bowels cos- 


246 Jlmerican Intelligence. 

tive, hand painful and swollen, pulse nearly natural. I prescribed Pil. 
Cath. U. S. No. iij. and an emollient poultice to wound. 

ISth, Morning. — Pills operated twice briskly, which nearly relieved the 
pain in the head and back, but there was still considerable pain in the hand, 
heat of skin and general uneasiness. Prescribed acet. ammon. 3ij; Sp. 
nit. dulc. 3ij; niorph. sulph. gr. \. Mix. S. tablespoonful every half hour 
till all taken. Two o'clock, p. m. medicine had produced no effect; all the 
symptoms had become aggravated. Venesection, ^xv. Night, considera- 
bly relieved, though still uneasy. Ordered Pulv. Doveri gr. xv. 

19?A, Morning. — Had some disturbed sleep, complained of no local 
pain, but general uneasiness. His mind was bewildered and wandering: 
with difficulty could be made to give direct answers to questions; could 
not tell where he was bitten, or when it first began to pain him. When 
pressed to describe his symptoms, said he felt very bad, had some pain in 
every part of his body. His eyes were glazed and dull, tongue a dark 
brown fur in the centre of a while coating. The wound was much swelled 
and very tense; tumefaction circumscribed. Upon the apex, about the size of 
a quarter of a dollar, it had assumed a mottled and gangrenous appearance. 
I made three or four incisions into it, which afforded considerable relief, 
and applied a warm emollient poultice. R. Submur. hydrarg. gr. xv.; 
morph. sulph. gr. ss. M. Ft. pil. iij. S. one every three hours. 

20//i, Morning. — Had wandered during the night, felt very weak, ap- 
pearance much relaxed and pale, extremities and tongue cool, no desire to 
take nourishment. R. Quinine sul. gr. vj. 2 p. m. quinine had decidedly 
a favourable effect, and he appeared calm; took some chicken soup. — 
Evening, no motion from the bowels since night before last. B. Pulv. 
Rhei 5ss. Soda sub. carb. Qj. M. 

21 s^.— Medicine operated once; much relieved, and coniinued to improve. 

25//i. — Called again to see the patient, who was complaining of severe 
pain, resulting from inflammation of the absorbents extending from the 
wound to the axilla. There was much heat, redness, swelling, and some 
general excitement. V. S. ^v., which, together with the use of cold 
applications, diaphoretics, anodynes to procure sleep, and after much suf- 
fering for five or six days, the symptoms gradually subsided and he was 
again convalescing. After the elapse of three or four days the inflamma- 
tion of the absorbents again showed a disposition to recur, but was dis- 
persed by the application of a blister over the part and nearly the whole 
length of the forearm. The thick skin in the vicinity of the wound had 
sloughed off, leaving the parts beneath of a dark brown appearance, appa- 
rently possessing but little vitality. 

Tenotomy for Club Foot successfully performed. — By W. M. Egbert, 
M. D. of Manayunk. 

A son of Mr. Jacob Coon, of Manayunk, was born with varus of the 
third degree in the left foot. When the child was 6^ months old, his fa- 
ther, who had heard of the operation for club foot, consulted me in regard 
to the propriety of correcting the deformity, anterior to the period of his 

Upon examination, I found the heel shortened about an inch and a half 
and drawn inward nearly to the malleolus internus, obliterating it com- 
pletely. The facia plantaris and anterior tibial muscles were considera- 
bly contracted. 


American Intelligence. 247 

The boy was well grown, fat and healthy. The process of dentition 
having just commenced, induced me to fear the effects of an operation; but, 
to allay the father's anxious solicitude, I consented to operate. 

Accordingly, on the 7lh of March, I divided the tendo Achillis and at 
once depressed the heel to a natural position, in the presence of Drs. T. 
F. Betton of Germantown, H. Chase of Philadelphia, I. L. Day of New 
Jersey, James M. Thomas of Centre county, Pa., and Messrs. Budd, 
Keim and Green, medical students. 

I applied the simple splint of Desault, with a single joint, and was there- 
by enabled to adapt its angle to the inclination of the foot. I prescribed 
an opiate, which kept the child composed during the night. On the fol- 
lowing morning, I found but slight symptoms of excitement, and the pa- 
tient had rested well through the night. 1 ordered a cathartic, which dis- 
pelled the irritation. No other unpleasant symptoms occurred, notwith- 
standing two inferior incisors made their appearance within ten days. 

1 have assisted my friend Dr. T. F. Betton and others in the operation 
and cure of several club feet, and my opinion is decidedly in favour of bring- 
ing the heel down at once, and causing the toes to be elevated beyond the 
natural right angle with the leg. I believe the operation to be extremely 
simple, and unattended with danger; and have been induced to make this 
case public in order to counteract, as far as possible, the impression that 
the operation should be deferred until many months have elapsed. 

The foot is now well, and none of the original deformity exists. 
April \st, 1840. 

Case of Club Foot cured by Division of Tendo Achillis. — By Wm. D. 
Lyles, M. D. of Pickensville, Ala. 

Sept. lOthf 1838. — To-day I operated for club foot on a child three 
years old. I divided the tendo Achillis an inch and a half above the heel, 
on the plan proposed by Dr. Stromeyer. So soon as I introduced the bis- 
toury and brought down the heel, the tendon separated with an audible 
sound. I proceeded to press it by applying a bit of adhesive plaster to 
the wounds on each side, which were not exceeding the eighth of an inch 
in extent. Next I applied a soft compress on each side of the divided 
tendon, and secured the whole by a roller, with the heel drawn upward, 
fixed in that position by the simple apparatus contrived by Dr. More. 

I2th. — This morning the tendon has united sufficiently to bear the use 
of the instrument. After it was applied, the little fellow was able to put 
his toes flat upon the floor. The parents expressed much satisfaction, and 
look confidently forward to a speedy cure. 

13/A. — To-day the instrument was removed. I find the progress of the 
operation to exceed by far my most sanguine anticipations. Without the 
instrument he was able to apply his toes to the floor naturally, which he 
had never done before — always, previous to this time, treading on the up- 
per portion of the foot. Nothing of any importance has yet occurred. — 
The instrument I have employed is one of my own construction; not dif- 
fering in any material point from those employed by other surgeons, either 
in make or the mode of application. I merely mention this fact, be- 
cause many, if they have not the proper appliances at hand, will not at- 
tempt to construct them, because they imagine they cannot do it. But 
this is not the fact. In nine cases out of ten, if the surgeon attempts it,, 
iie will he able to fojrm something that will answer his purpose. 

S48 ^Smerican InteUis^ence 

In ten days my patient had recovered. The cure was perfected by the 
judicious application of a shoe. I now have the satisfaction of seeing my 
little friend almost daily, perfectly cured. 

I have thought proper to communicate to you the above extract from my 
case book; not because I think the operation or its detail contains any par- 
ticular merit, but from the circumstance that it has of late become a fa- 
vourite subject with the profession. 

I cannot close these remarks without doing full and ample justice to my 
friend and former preceptor. Dr. Smith, then of the University of Mary- 
land, by saying that it was from him, in 1836, I received the most valua- 
ble hints upon this important subject. 

Feb. 24, 1840. 

Case of Gun-shot JVound of the Head and Brain. — Recovery. By 
H. Janson, M. D. of Batavia, Genessee county, N. Y. 

On the 19th of September last, I was summoned to an adjoining town 
to see the patient, Madison Moore, aged about 19. His constitution was 
good, and apparently free from any hereditary predisposition to disease. 
On the morning of the 19th, he left home, with his rifle, to go upon a 
hunting excursion. He called, in the neighbourhood, at a cooper's shop, 
for a second person to join him. While there, he sealed himself upon a 
work-bench, elevated a few feet from the floor, and negligently placed his 
rifle, which was charged, between his legs, with the muzzle pointing to- 
wards his face. The gun was furnished with a percussion lock and the 
cone capped. In the act of passing the left foot to the floor, the inner edge 
of his foot hit the tip of the lock and sprung it sufficiently to explode the 
cap and with it the rifle. The mouth of the weapon happened to be in 
range with the upper ei\ge of the left nostril — the bullet consequently laid 
open this passage to the nasal bone — speeding onwards it then penetrated 
the skull at the inner angle of the corresponding superciliary ridge, just 
within the socket of the eye, and, passing upwards, emerged from the 
cranial cavity, through the os frontis, at a point about two inches above the 
place of entrance. In its progress both tables of the frontal bone were 
shivered; but the skin covering the track was quite intact, lacerated only 
at the entrance and exit of the ball. 

I saw the sufl^erer within an hour and a half from the occurrence of the 
accident. He was at this time stretched upon a pallet of straw, weltering 
in his blood, near the spot where he fell. The position was supine — 
the whole cuticular surface cold and livid — the pulse, 140 per minute, 
tremulous and weak — coma, eyes closed, and breathing deeply sterto- 
rous. The insensibility was so great that he was only slightly roused 
"when I divided, by an incision, the skin covering the track of the ball. 
From appearances there was about 12 oz. of blood lost, and particles of 
cerebral substance were seen scattered upon the floor. I learned from Dr. 
Jas. H. Billings, who saw M. near the period of the accident, that two 
convulsions had followed each other after he arrived. 

I carefully sponged the blood from both wounds and removed pieces of 
bone and detached portions of brain from the skull, and ascertained the 
groove in the anterior lobe of the left hemisphere was in its greatest depth 
six lines. The wound in the forehead was then dressed by adhesive plaster, 
a bread and milk poultice and bandages — the ala of the nose was adjusted 
and retained by three sutures and adhesive straps, and a small quantity of 
diffusible stimulants were given to revive the waning powers of life. 

American Intellwence. 249 

The 20th, I saw the young man at his father's liouse, whither he had 
been conveyed upon a bier the day previous, in a senseless condition — his 
state still comatose and breathing stertorous — surface warm, pulse full, re- 
gular, and 120. V. S. 16 oz. and a dose of snip. mag. was ordered. 

21*^. — A good evacuation had been obtained during the night. Pulse 
bounding and 110, and great reaction. V. S. 16 oz. 

22(/. — Pulse yet strong and 90; breathing less laboured, and could be 
roused with some difficulty, but again relapsed. The head had now be- 
come very hot, and the pulsations of the brain were remarkably distinct 
upon the left upper surface of the head, where an area of the skull had 
been fractured when the ball made its egress. This portion of the skull 
was about three inches in diameter. V. S. 12 oz. As the bowels had 
not been opened for the last 24 hours, 1 oz. of Sulph. mag. was directed, 
and followed with injections. 

23^.— An abscess was discovered, pointing at the summit of the head, 
which, on being opened, discharged half a gill of fcetid pus. From this 
time the functions of the brain were gradually restored, and no untoward 
symptoms supervened, excepting a fungus cerebri vegetating from the en- 
tire length of the wound of the forehead. It grew daily, until, in three 
days, it projected six lines from the surface of the skin and downwards 
over the eye. The dressings were continued as usual, and I removed from 
day to day, with a scalpel, layers of the tumour, without any attending 
hemorrhage or inconvenience to the patient. This was persevered in until 
the fungus was reduced below the surface of the skin. 

About ten days from the date of the injury, adhesive straps and simple 
cerate were the only dressing, until the wound had entirely healed. For 
the first twelve days in this case, M. passed his urine and faeces without 
giving any intimation. After this, signs were made when the rectum was 
to be emptied, but the urine was voided as usual. This was done for a 
few days, after which, when the offices of nature were to be performed, 
the attendants were duly notified. There has been no paralysis of any 
organ at any time; and correct but short answers given to questions put to 
him from the time he was capable of opening his eyes. The patient was 
kept on a mild diet, and the room shaded and perfectly quiet. 

I have now the happiness to see my patient restored to health, and in 
the enjoyment of all his faculties, excepting, perhaps, a slight imperfection 
of those organs phrenologically ranged in the course of the ball.* 

Views and Treatment of an Important Injury of the Wrist. By J. R. Barton, 
M. D. — Any farther observations on a class of accidents, so common, and which, 
have been so often the subject of inquiry, as that of injuries of the forearm and 
wrist-joints, may be deemed superfluous by those who read, but have no per- 
sonal experience in surgery. But to those engaged in the active pursuits of our 
profession, it is well known that, notwithstanding the volumes that have been 
written on this subject, there are yet certain injuries involving these parts which 
are not fully understood, and consequently not successfully treated. 

My attention was early fixed upon such cases, and through a series of years 
they have been particularly interesting to me; and it is from my conviction that, 
up to this time, error prevails, both as to the nature and the treatment of them, 
that I am induced to publish my views and practice therein. 

I do not know any subject on which I have been more frequently consulted 

* We hope our correspondent will favour us with some more precise information 
relative to this last point. — Ed, 

250 American Intelligence. 

than on deformities, rigid joints, inflexible finaers, loss of the pronatinor and 
supinating motions, and on neuralgic complaints resulting- from injuries of the 
wrist, and of the carpal extremity of the forearm — one or more of these evils 
having been left, not merely as a temporary inconvenience, but as a permanent 

The accidents v^^hich are to be the principal subject of my remarks, usually 
pass either for sprains or dislocations of the w^rist. Under one of these deno- 
minations are these cases to be detected, which, though partaking somewhat of 
the character of sprains or dislocations, are distinguishable from either of them 
respectively. They may be recognised by their being accompanied by more 
distortion of the hand and arm than any which can arise from simple sprains of 
the wrist, and yet less than that which must necessarily take place when there 
exists a complete luxation of the carpus. The profile of the limb under this 
injury is a peculiar one, distinguishing it on the one hand from the sprained 
wrist, and on the other from luxation. 

A nice discrimination between these and the other varieties of accidents is not 
a mere matter of useless refinement in diagnosis; but it is one of great practical 
importance; as is confirmed by the number of persons who have never fully 
recovered from the effects of accidents of this nature, treated without such dis- 

In simple sprains of the wrist, though accompanied by extreme swelling, the 
limb will still be found to retain a characteristic outline of its natural contour. 
It is not marked by any abrupt and solid eminences, the swelling is rather uni- 
form, diffuse, and puffy, the hand continues on the same line with that of the 
forearm, &c. In complete dislocations, the nature of the injury must always be 
very palpable from the great bulging of the overlapped bones, and from the 
shortening of the limb, &c. Between these two injuries there is too great a 
dissimilarity to admit of an excuse for the surgeon who mistakes the one for the 
other; but he may confound v^^ilh these, and it is a common fault to do so, a sub- 
luxation of the wrist, consequent to fracture through the articular surface of the car- 
pal extremity (f the radius^ although to this accident belong appearances exclu- 
sively its own. 

It is to this peculiar injury that I wish to draw attention. 

It is one of the most common injuries to which the upper extremities are sub- 
jected; and every practitioner of moderate experience will, I am sure, be able to 
call to his recollection the appearance which the limb presents under such cir- 
cumstances, as well as the embarrassment which he has experienced in his 
attempts to obviate eventual deformity, to preserve the functions of the fingers, 
and to restore the motions of the wrist and forearm. 

The similarity of manner in which this accident generally occurs, is striking. 
It is almost always found to have taken place in consequence of the individual 
having thrown out his hand to rescue himself from falling, or to ward off injuries 
threatening a more important part of the body. In the act of falling, for exam- 
ple, the hand is thus instinctively thrown out, and the force of the fall is first 
met by the palm of the hand, which is violently bent backward until the bones of 
the wrist are driven against the dorsal edge of the articulating surface of the 
radius, which, being unable to resist, it gives way. A fragment is thus broken 
off from the margin of the articular surface of this bone, and is carried up, before 
the carpal bones, and rested upon the dorsal side of the radius; they having been 
forced from their position, either by the violence, or by the contraction of the 
muscles alone. We have then an imperfect luxation of the wrist, depending on 
a fracture through the extremity of the radius. The deformity will be found to 
correspond with this state of the case. There is a tumour on the dorsal side of 
the arm formed by the bulging of the carpal bones and fragments; whilst below 
it, on the palmar side, the extremity of the radius projects. The degree of 
prominence of these parts, depends upon the size of the fragment and the vio- 
lence of the injuring force. The ulna not being very intimately involved in 
the injury, retains its position, and serves as an abutment, against which the 
hand seems to rest; whilst the radius, as it has its edge broken off, allows the 

American hit elli 9^ ence, 251 

hand on that side to be drawn upward, and hence to render, on the under side, 
tiie styloid process of the uhia more conspicuous than natural. Crepitus cannot 
always be felt, sometimes in consequence of the smallness or crushed' condition 
of the fragment; at other times, owing to the great swelling and tension; but in 
every such case, the distortions of the limb are to be seen, and may be removed 
by making firm extension and counter-extension from the hand and elbow, at the 
same time gently depressing the tumours already spoken of. By the employ- 
ment of these means, all deformity, except that which evidently depends upon 
the more general swelling, may be satisfactorily removed; but the moment the 
extension and counter-extension are relaxed, the combined action of the flexors 
and extensors of the fingers, as well as those of the wrist, force the deformity to 
reappear as conspicuously as before, and as often as the effort is renewed and 
discontinued, will the deformity appear and disappear. In this respect does this 
species of injury in an especial manner differ from a complete simple luxation of 
the wrist; which, when once reduced, must continue so after the reducing force 
has been withdrawn. There is no spontaneous reluxation after the simple com- 
plete dislocation has been removed; whereas, in this case it immediately succeeds 
the withdrawal of the force. This accident must not be confounded with those 
which are also of frequent occurrence, namely, fracture of the radius, or of the 
radius and ulna just above, and not involving the joint. It will be found on re- 
ferring to the writings of Boyer, Desault, Sir Astley Cooper, Dupuytren, and 
many others, that this frequently happens, and that the fracture often readies to 
within a few lines of the extremity of the bone; and that these cases are very 
frequently mistaken for dislocations, though they are in reality fractures exterior 
to and disconnected with the joint; the deceptive deformity being occasioned by 
the displacement of the broken ends of the bone caused by the action of the mus- 
cles and the weight of the hand. A very good illustration of such cases may 
be found in plate 12, figure 1, in Mr. Hind's folio work on fractures of the ex- 
tremities. Ii may there be seen how powerfully the flexors and extensors act 
in retracting the inferior portions of the bones, and how closely the radius and 
ulna are drawn together through the instrumentality of the pronator quadratus 
muscle below, whilst toward the? brachius the pronator teres is exerting its 
power to keep the limb in a state of pronation. Now these are consequences 
which do not result from the species of injury to which I refer. The fragment 
maybe, and usually is, quite small, and is broken from the end of the radius on 
the dorsal side, and through the cartilaginous face of it, and necessarily into the 
joint. The pronator quadratus is not involved in the fracture. The radius and 
ulna are not materially disturbed in their relations to each other. The only im- 
portant change, which takes place in consequence of this fracture is, that the 
concave surface at the extremity of the radius, which receives and articulates 
with the three first carpal bones, is converted, as it were, into an oblique sur- 
face by the loss of a portion of its marginal ridge; commonly by the separation 
of an entire piece; sometimes by the crushing of its substance. The moment 
the cartilaginous extremity of the radius is deprived of its concave form, the 
united force of the carpal and digital flexors and extensors is exerted to create a 
complete luxation; but as the ligaments are only stretched, or but partially torn, 
this cannot take place. The carpal bones, therefore, only emerge collectively 
from their natural position, and carrying before them the broken piece, rest on 
the dorsal side of the radius, forming a tumour there; whilst the end of the radius 
itself occasions on the palmar side a prominence which is round and smooth, 
and differing in this from similar projections formed by the fractured ends of 
bones, the abruptness and harshness of which may sometimes be distinctly felt 
through the soft parts, and which are themselves, when pressed upon, acutely 

It follows of course, in injuries of this kind, that unless some method of dress- 
ing be adopted whereby the retraction of the hand may be permanently counter- 
acted, and the prominences repressed, the patient will recover with a crooked 
arm, and under a sacrifice of some of the functions of the hand. The customary 
modes of treating either sprains or dislocations of the wrist, or fracture of the 

253 American Intelligence. 

forearm, are totally inadequate to the purpose, and should not he relied on as a 
treatment for these particular cases hy any practitioner who has regard for the 
welfare of his patient, and for his own reputation. There is no prefessional 
point upon which I can more confidently express myself, than upon the errors 
committed in the treatment of these cases — passing-, as they commonly do, for 
sprains of the wrist, and hence treated as such. After an unvarying success in 
the management of this accident for many years in the Pennsylvania Hospital, 
in the Blockley Hospital, and in private practice, I can strongly recommend 
the following plan of treatment: — Two thin, hut firm splints of wood, are to be 
prepared, of sufficient length to extend from just below the condyles of the os 
humeri to the ends of the fingers, and of width enough to embrace the sides of 
the limb. These are to be lined on one of the sides with carded cotton, or some- 
thing equally soft, and wrapped with a bandage. Two compresses, each about 
two inches square, and composed of strips of bandage about one yard and a-half 
long, evenly folded up, are also to be in readiness. The arm is then to be flexed 
at the elbow, and one assistant is to hold it firmly above the condyles, whilst 
another makes extension from the fingers. The surgeon now presses the promi- 
nent end of the radius on the inner side, and the bulging carpus and fragment 
on the outer side, into their respective places. The roller is then to be lightly 
pressed around the hand and arm, securing in its course up the limb one of the 
compresses precisely over the carpus and hack of the hand, and the other with 
equal precision over the palmar side of the radius just above its carpal extremi- 
ty. These compresses, when properly arranged, will be found not opposite to 
each other, hut the inner one commencing on a line opposite to that on which the outer 
one has terminated. These being applied, the inner splint is next placed against 
the limb — the assistant shifting his hand to admit of this being done, without 
his relaxing in the least degree the extension until the limb is bandaged to this 
splint, when it will be found that the extension is well maintained. The outer 
splint is now to be applied and secured to the arm by the return of the roller. 
The principal use of the latter splint is to act upon the outer compress, and by 
its general pressure to weaken for the time the force of the resisting muscles. 
By the employment of these simple means, tiie indications in the treatment of 
this accident will be found to be fully met. The arm may be carried in a sling, 
and the patient permitted to walk about, &;c. In three or four days the limb 
should be undressed and inspected; and whilst held so that relaxation cannot 
take place, the wrist and fingers are to be bent enough to preserve the flexibility 
of the joints. The dressings are then to be reapplied. These operations are 
thenceforward, for four or five weeks, to be repeated every day, adding to them 
the motions of pronation and supination. 

The practice of keeping a limb in splints, with the joints in an immovable 
state for weeks, even when the fracture is remote from the articulation, cannot 
be too earnestly deprecated; and in cases where the injury to be repaired has in- 
volved a joint, such treatment is censurable to a high degree, as it is almost cer- 
tain to diestroy the mobility of it by promoting the adhesion of ligaments, the 
union of tendons with their thecse, and by obliterating bursas— evils never to be 
fully repaired. So prevalent is the error on this point, and so serious are the 
results of such practice, that I have settled my mind to the belief, that in very 
many cases of fractures the imperfect recovery of the patient is owing to the in- 
judicious use of splints and bandages, rather than to the complication or original 
difiiculty of the case. For the interruption of adhesions of the ligaments, for 
insuring a continuance of the muscular power and offices of the tendons, and for 
the entire preservation of the motions of joints, it is indispensably necessary 
that these parts should be put into action frequently during the treatment of a 
fracture in which they are interested, either from the adjacency of the fracture, 
or from their confinement by the splints necessarily used on the occasion. The 
movement of these parts by the surgeon at stated periods, is not at all incom- 
patible with the quietude and the progressive reunion of the bone itself. The 
omission of this duty arises, I am persuaded, out of our knowledge of the neces- 
sity of securing rest to a broken bone, without at the same time considering 

American Intelligence. 253 

that by the means we employ, and the course we pursue to accomplish it, we 
may entail upon our patient a calamity quite as deplorable as that of an ununited 
fracture or a crooked bone— namely, a stiff and useless limb. The surgeon, 
then, is to recollect, that in the cases made herein the special subject of notice, 
he has not only the duty to perform of obviating deformity of the limb, but of 
preserving the free motions of all the other parts, and that this can be accom- 
plished only by daily trials of their freedom and functions. 

By an adherence to the plan of treatment just recommended, and by an atten- 
tive pursuance of the means spoken of to preserve the functions of the limb, I 
have uniformly succeeded in restoring perfectly the arm to its natural shape and 
offices. I can, consequently, on just grounds, advise others to adopt the same 

It sometimes happens, also, though rarely, that fracture of a similar character 
to the one just described, occurs en the palmar side of the radius, from the appli- 
cation of force against the back of the hand whilst it is bent forward to its 
ultimate degree. This usually happens in awkward attempts to parry the blow 
of a fist, from pressure in dense crowds, and from falling on the back of the hand 
whilst it is bent forward. Whenever the fracture takes place in front, the end 
of the radius projects over the wrist on the dorsal side, and the carpal bones and 
fragment rise out of their proper situations, and form the tumour on the palmar 
side, thus reversing the deformity of the arm. The principle in the treatment 
of this variety of the injury, is the same as in the foregoing. 

Dupuytren used to trace an analogy between the ordinary fracture of the lower 
end of the radius, and fracture of the lower end of the fibula; and as he had 
founded a very successful method of treating the latter injury from the view he 
took of such cases, he extended his analogy to the treatment of the former by 
means and apparatus designed to accomplish the same ends. How far the 
practice may be successful when applied to the cases for which the practice was 
specially intended, I cannot say. Having myself found simpler means attended 
with success, I never adopted this practice; but for the treatment of fracture 
through the joint, &c., the practice would be unavailing. Neither is there any 
resemblance of this injury to the fracture of the fibula. It may be, however, 
not inaptly compared to the partial luxation of the foot, depending on fracture of 
the internal malleolar process of the tibia, including a portion of the articular 
face of the bone — an accident well known to surgeons. — Med, Examiner. 

The late Br. Joseph ^arrish. — It is with regret that we have to notice the death 
of this eminent and greatly respected physician, which took place in this city 
on the 18th of March last, in the 61st year of his age. 

When Dr. Wood shall have completed the task to which he has been ap- 
pointed, we hope to present a biographical sketch of the deceased. In the mean- 
time, for the gratification of his numerous friends, we insert the history of his 
case; and an account of the proceedings of the different public bodies with 
which he was associated, on learning the loss they had sustained. 

Case of the late Dr. Joseph Parrish. Reported by Geo. B. W^ood, M. D., Pro- 
fessor of Materia Medica in the University of Pennsylvania. 

The following account of the case of the late Dr. Joseph Parrish is drawn up 
from memory, no notes having been taken during its progress. 

When about twenty-five years of age, the Doctor was affected with a severe 
and lasting cough, and considered himself in danger of pulmonary consumption, 
to which he believed that he had a family predisposition, having lost a brother 
and sister by that complaint. Under- a course, however, of vigorous exercise 
and free exposure to the air, without the use of medicines, he ultimately sur- 
mounted the threatening symptoms. The existence of cicatrices in the upper 
portions of the lungs, discovered upon post mortem examination, proves that 
his apprehensions were well founded, and at the same time affords strong evi- 
dence in favour of the plan of treatment which he adopted in his own case, and 
always strenuously advocated. 

No. LI.— xMay, 1840. 22 

254 American Intelligence, 

For many years after the disappearance of the pectoral affection, Dr. Parrish 
suffered much from dyspepsia, which continued with him even till middle life. 
But from this also he was at length relieved, and afterwards enjoyed good 
health, with the exception of occasional severe attacks of catarrh during the 
winter, and of irregular gouty or rheumatic affections, particularly of lumbago, 
which usually continued but for a short period. In one of these attacks, how- 
ever, of irregular gout, which occurred about eleven years previously to his last 
illness, he was confined to his bed a long time, and suffered extremely. The 
disease appeared to affect chiefly his stomach, diaphragm, intercostal muscles, 
and upper extremities; and he was at one time considered in imminent danger. 
He had a slow convalescence, but recovered entirely, without any apparent 
relics of the disease, which could give rise to uneasiness. His predisposition 
to gout was thought to be hereditary. 

It may be proper to mention, in reference to the state of the kidneys and pro- 
state glands, revealed by dissection, that he laboured, during the greater part of 
his life, under more or less irritation of the urinary passages, and that the secre- 
tion of urine was more copious than is usual in health. He believed that in 
early life he had suffered from a slight attack of diabetes. 

These preliminary facts are stated, as they may throw some light upon the 
character of the affection of which he died, and upon the phenomena observed 
after death. 

The health of Dr. Parrish began to decline in the early part of last summer. 
He lost flesh, and felt uncomfortable, without being able to ascribe his condi- 
tion to any particular cause. In August, 1839, he visited Saratoga, with the 
view of improving his health, and while absent from hoihe, was attacked with 
a severe neuralgic affection of his lower extremities. This was so far relieved 
by opiates as to enable him to return to Philadelphia, but did not entirely dis- 
appear for several weeks. The chief seat of the affection was in the calf of the 
left leg. The pain was excruciating, but without heat, redness, or swelling of 
the part. It yielded to very copious local depletion, by means of leeches. 

After this attack he never recovered his former health. His appetite was 
impaired, his bowels often costive, his sleep disturbed and not refreshing; and, 
though he continued to attend to his professional duties, he exhibited less energy 
than formerly, and in the afternoons was indisposed to exertion, sleeping much 
in his chair, and often waking up in a debilitating perspiration. Soon after the 
commencement of winter, he was seized with catarrh, which gradually increased, 
and at length became so severe as to render confinement prudent if not neces- 
sary. It was not, however, till about the first of January that he concluded to 
remain at home and try the effect of remedies. 

He was now much more emaciated, had a pulse of about one hundred, and 
apprehended phthisis; and it was the conviction that he was predisposed to this 
complaint which had induced him to delay confinement. But the existing 
pectoral symptoms were obviously those of bronchial inflammation, and yielded 
very considerably to a slight mercurial impression produced by the blue pill. 
The general amelioration of his condition, under the influence of mercury, was 
indeed very striking. Expectoration, which was before deficient, became esta- 
blished, the cough was diminished in violence, and the pulse sunk down to the 
natural standard. He was so much improved as to be able to leave his house 
occasionally, and even to visit patients, when the weather was favourable. But 
he was still far from being well. The emaciation continued, and the cough, 
though moderated, did not altogether leave him, but took on a laryngeal character, 
as if the irritMion which produced it was seated chiefly in the glottis. The 
pulse again became more frequent than natural, and he began to have a sallow 
hue, though the alvine evacuations and the urine were little, if at all, changed 
in colour. Petechiae made' their appearance pretty thickly upon the lower ex- 
tremities, but were not permanent. Though the appetite was somewhat im- 
paired, enough food was taken for healthy nutrition, had not some latent cause 
existed to disturb the process. 

After exposure out of doors, and fatiguing professional exertion, on the 29th 
of February he became so much worse as to be confined to his room, which he 

American Intelligence. 25S 

did not afterwards leave. His cough was now almost exclusively laryngeal, 
and occurred paroxysraally towards the close of the day, when it became ex- 
ceedingly violent, and continued almost incessantly for hours. The sensation 
in his throat was such that he could scarcely convince himself that there was 
not a foreign body in the larynx. Tlie slightest attempt to speak brought on 
violent convulsive attacks of coughing, which were attended with shooting pain 
in the throat, and not unfrequently also with vomiting, consequent, probably, 
upon the agitation of the parts about the fauces. The stomach was at length 
thrown into a state of sympathetic irritation, which continued even during the 
absence of the cough, so that scarcely anything swallowed could be retained. 
The pulse was how usually between ninety and one hundred, soft and moder- 
ately full; the skin soft and of a natural temperature; the tongue slightly furred, 
and disposed to dryness; the secretion from the kidneys and liver very nearly 
healthv in appearance, though the evacuations from the bowels were sometimes 
rather too light coloured, and the urine rather too yellow. The sallowness and 
emaciation had somewhat increased, and a slight disposition to lethargy was 
observable, which appeared to have existed for some time previously, though it 
had not attracted particular attention. There was no unusual irritation of the 
urinary passages; no pain in the small of the back, nor in the right side or 
shoulder; no difficulty in lying in any position; very little, if any, tenderness in 
the right hypochondrium, in short, none of the usual evidences of inflammation 
of the kidneys or liver, though the lethargic symptoms, and the somewhat 
jaundiced condition of the skin and eyes, might seem to point to these organs as 
the seat of disease. 

A blister %yas applied to the throat; the blue mass and hyoscyamus were 
taken in small doses frequently repeated; cream or milk, with lime water, was 
employed as food, and to allay the sickness of stomach. The gums soon 
became somewhat sore, without any material amendment of the symptoms, and 
the mercurial was omitted. An attempt was made to interrupt the paroxysms 
of coughing, by quinia; but this was omitted, after a few grains had been taken, 
in consequence of the irritation of stomach which it produced. With the same 
view, enemata of laudanum were administered in anticipation of the paroxysm 
for two or three days successively. This remedy produced the desired effect, 
and the harassing laryngeal cough ceased almost entirely, but the irritation ap- 
peared merely to have receded, and the increase of the lethargic symptoms, and 
the almost constant sleepiness which came on, indicated, but too plainly, that 
it had been transferred to the membranes of the brain. 

Up to this period. Dr. Parrish, thopgh occasionally seen by medical friends, 
had kept the management of the case in his own hands. Drs. Wood and Otto 
were now called into consultation with Dr. Isaac Parrish; though even till 
within two days of the close of the disease, the mind of the patient, when suffi- 
ciently aroused, acted with entire clearness, and his opinions were necessarily 
allowed some weight in the treatment. Towards the close of the case. Dr. 
Hewson was associated in the consultation. 

A few leeches were applied to the temples, and mustard to the feet. Calomel 
was given in minute and frequently repeated doses, and the diet was continued 
as before. The drowsiness was somewhat diminished, and the stomach became 
more retentive, but the case was complicated by the occurrence of singultus, 
which gradually increased, and soon became one of the most prominent symp- 
toms, continuing, with occasional interruptions, till a day or two before death. 
Neuralgic pains also occurred in the left thigh and leg, and some soreness was 
observed along the upper part of the spine. The latter affection increased by 
•degrees, occupying chiefly the back of the neck and the left shoulder, and be- 
came at length so severe as greatly to impede motion. Towards the close of 
the case, it constituted almost the sole source of complaint. 

The remedies employed were chiefly calomel in small doses, as before; musk; 
creosote, assafetida by enema, and other antispasmodics, for the relief of the. 
hiccough; magnesia and rhubarb, with terebinthinate enemata, as laxatives; 
blisters to the extremities, and over the stomach; acetate of morphia in small, 
quantities to the blistered surface in the epigastrium, and dry cups to the back 

256 American IntelUo'ence. 


of the neck, with the abstraction of an ounce or two of blood from the same 
part. The diet consisted chiefly of cream and chicken broth. There was a 
constant desire for cold drinks, in which the patient was indulged, carbonic 
acid water being preferred, as it quieted the irritability of the stomach. Opiates, 
moderately given, relieved distress.without increasing stupor, but were thought 
to be followed, when their immediate effects went off, by an increase of nausea, 
and were used as little as possible. The loss of blood, though indicated by 
some of the local symptoms, was forbidden by the steadily increasing prostra- 
tion, and even the slight local bleeding was not well borne. 

The treatment seemed to have no other effect than a temporary alleviation of 
the distressing symptoms. The disease marched steadily onward. The leth- 
argy increased, the skin became quite jaundiced, the abdomen tympanitic, the 
pulse more frequent and feeble, and the bowels obstinately costive. Subsultus 
tendinum came on, but there was no paralysis. The only additional remedies 
employed were the oil of turpentine, and aromatic ammoniated alcohol. Towards 
the end of the complaint the sight and hearing were greatly impaired, and for 
twenty-four hours before death seem to have been altogether lost. In the 
midst of the lethargy there were evidences of considerable physical uneasiness, 
but this entirely disappeared during the last three or four hours, and life was 
gradually extinguished without convulsions, or other distressing symptoms. 

Death occurred on the 18th of March. 

Notes of an examination of the body of Br. Joseph Parrish, March 19, 1840, 
thirty-two hours after death. Present Drs. Otto, Wood, Ashmead, Pennock, 
Gerhard, Kirkbride, Barton, and West. 

Jaundiced tint of skin — Emaciation efface very decided, — no infiltration. 

Head. — Scalp unusually dry and bloodless; the yellowness extending to the 
pericranium: adhesion of dura mater to cranium unusually strong; veins of upper 
part of brain nearly empty; at least three ounces of serum exuded from beneath 
the arachnoid; this membrane upon its upper surface semi-opaque, and elevated 
by the effused serum; arachnoid not adherent, cloudy, not granulated, quite pale; 
convolutions distinct, pale, firm; consistence of upper part of cerebrum even 
greater than usual; both substances extremely pale, with a faint, yellowish 
tinge; cortical substance projecting above the level of the medullary, and rather 
disproportionately firm; cerebral substance, in general, extremely firm. One or 
two drachms of serum in the ventricles. Plexus Choroides moderately injected. 
Thalami and corpora striata firm and normal. 

Base of brain offered about two ounces of serum; appearance of this part 
remarkably healthy, with barely average injection. The membranes are scarcely 
injected or opaque; substance of brain and cerebullum pale and firm. 

Thorax. — On right side some adhesions are found posteriorly, with effusion 
into pleura of half a pint of reddish serum. The right lung at its summit pre- 
sents an irregular puckered depression, which is firm and opaque; upon cutting 
into it, there is found a substance for the most part of a dirty grayish colour, 
nearly cartilaginous in consistence, with some grains of a calcareous matter in 
it, evidently the cicatrix of an old tubercular cavity of small size. From"the 
back part of this depression there extends another one, which is more irregular, 
running round the lung, and connected with similar deposit. Upon stretching 
and pulling the lung slightly, cellular tissue maybe discovered passing through 
this hardened mass, and apparently constituting it. Several large vessels may 
be seen passing around the above cellular substance; one or two slighter depres- 
sions of the same kind are found in the adjacent parts of the lung. The sub- 
stance of the lung generally is gorged with serum, crepitous, and contains air; 
the vessels are more or less enlarged; the pleura of the upper third of the lung 
is more or less opaque, giving to the whole of this portion of the lung a peculiar 
wrinkled aspect, less marked, however, than at the summit. The mucous 
membrane of the bronchial tubes, opaque, jaundiced, but not reddened. 

Left Lung. Nearly as much serum in the pleural cavity of this side as in the 

right one, of same character; the lung free from adhesions; its lower lobe more 
engorged with blood than the right, but containing less serum; still crepitous 

American Intelligence, 257 

throug-hout; upper lobe in its lower three-fourths paler than natural; some 
emphysema along* its anterior margin; tissue engorged with bloody serum; con- 
taining- air; its upper one-fourth hardened and puckered, but less so than on the 
right side; whole tissue somewhat solid and condensed. Several masses of 
cellular substance of the same colour as those in the right lung are found in it, 
two of which are particularly well defined, and present an irregular central nu- 
cleus, one-eighth of an inch in diameter, from which run radii, of firm cellular 
substance; appearances still more characteristic of cicatrization. No recent 
tubercular granulations, nor any trace of recent tubercular deposition are any 
where discoverable. 

Heart. — The pericardium contains about two ounces of bloody serum; the sur- 
face of heart is remarkably free from opacity; no adhesion of pericardium, except 
slightly at the vessels; left ventricle soft, slightly jaundiced; a little thickening 
about the mitral valve. Semi-lunar valves flexible, but a little cartilaginous at 
their base, not, however, sufficiently tointerefere with their action. Some carti- 
laginous deposit beneath the inner membrane of the aorta immediately above 
the valves. Right ventricle of the same colour with the left; stained somewhat 
yellowish; valves flexible. 

Mdomen. — The peritoneum contains more than a quart of reddish-yellow 
serum. The liver is extremely irregular in outward appearance; its surface is 
completely studded with irregularly rounded elevations. Some of these are 
about the size of grains of rice, others two or three times as large. The left 
lobe is shrunken to half its size; the right a little less than usual. The tissue 
of the liver is extremely heavy and condensed. The tuberosities of its substance 
are more marked in the left than in the right lobe, and vary in size from a pin's 
head to a hazel-nut. The colour is a light fawn — cellular substance much atro- 
phied. The seat of the morbid deposit is evidently in the acini, which vary 
extremely in size. The blood in the vessels of the liver is thin and watery. 
The left lobe, when incised, is paler than the right one, and the extreme carti- 
laginous firmness is even better marked in it. The granulations of the substance 
are also much more distinct and numerous in the left lobe. The liver is not 
fatty ^ but on the vsdiole presents a remarkable specimen of that peculiar change 
in its structure termed cyrrhosis. The bile is thin and greenish; in the gall 
bladder are found six dark green mulberry calculi, about the size of peas — the 
lining membrane of this part is thin and pale. 

Spleen. — Rather firmer than natural; six inches by four. 

Stomachs — Of a greenish and reddish colour at its great cul-de-sac, evidently 
from commencing decomposition; it contains a little thin mucus; its cardiac 
extremity is of a deep red colour, chiefly from imbibition; its lining membrane 
has Been finely injected — not softened; rest of its surface marbelled with red 
and green, mamellated and slightly thickened. {Note. — The commencing state 
of decomposition of the stomach makes these leisions rather doubtful, but evi- 
dently this organ has been the seat of chronic inflammation and thickening.) 

Kidneys. — Left one very large, with great abundance of fat about it; upon 
removing it, we opened into a sac which was filled with purulent liquid; the 
sac containing the pus occupies half the anterior, and the whole posterior of the 
kidney, except at its summit — it is formed by the proper membrane of the kid- 
ney, which is detached from it, and in this way constitutes the abscess. The 
posterior part of the kidney presents, near its inferior extremity, an adheision an 
inch and a half in diameter, rounded, the membrane adjoining it is evidently a 
purulent membrane, which here and there has small, rounded ulcerations in it. 

The yellow spots, observable on its surface, connected with the membrane of 
the kidney, and forming the points of adhesion to it, constitute the exterior of 
the masses of purulent infiltration into the cortical substance of the kidney. 
The cellular substance of the kidney remains, but no trace is to be found of the 
true renal structure; near, and above this, is another purulent infiltration of 
irregular size, of which there are several throughout the cortical portion, consti- 
tuting, in fact, small abscesses, the largest of which will contain an almond. 
About one-fourth of the kidney retains, in part, its normal appearance, but is 


258 American Intelligence, 

filled with the yellow granulations of the acini, which are evidently those of 
Bright's disease. The exterior of this portion of the kidney presents a yellowish 
chagrined appearance from the projection of the same granulations. The whole 
of the kidney is enlarged about one-third, lobulated; the ground work of it is of 
a more livid colour than usual, and soft. 

Right Kidney about of natural size; investing membrane adheres closely to it; 
on separating it, the same yellow points, mentioned before, were observed, some 
of which are from one-half to three-quarters of an inch broad, prominent, soft, 
and, on penetrating them, they are found to be filled with pus of perfectly 
healthy appearance. The substance of the kidney, generally, is of a deep red 
colour, dotted with darker brownish points; at the posterior and inferior part, on 
detaching the membrane, we open into an abscess containing about two ounces 
of perfectly creamy, laudable pus, which is contained in a similar infiltrated 
mass, formed by the cellular substance, here and there thrown into joocAes, (very 
similar to forming abscesses in the lungs,) which do not seem to communicate 
with the calices of either kidney. The rest of the kidney, in its cortical sub- 
stance, is filled with minute granulations; less marked, however, than in the 
left one; the cortical substance is soft, reddish, and evidently inflamed. 

Bladder very nearly natural; slight roughness of its lining membrane, at its 
inferior portion, like grains of sand on it. 

Pancreas contains more blood than usual; harder; ecchymosed throughout; 
lobules firmer than usual, harder. 

Prostrate gland not enlarged, its texture changed internally in about one-half 
of it, to an almost cartilaginous firmness, of a yellowsh tinge, not grating under 
the knife; upon squeezing it, a purulent fluid is poured out, apparently the secre- 
tion of the glands; upon cutting into it, the same fluid is seen in small points 
through it. 

Large intestines opened in several places; contain yellow faeces; mucous mem- 
brane of a slate colour; no ulceration found at any point observed. 

Small intestines of same appearance, apparently perfectly healthy. — Med. Exam, 

Tributes of Respect to the late Dr. Parrish. — At a special meeting of the Mana- 
gers of Wills Hospital, held on the 18th instant, the Secretary having announced 
to the Board that a dispensation of Divine Providence had removed from among 
them their late respected fellow citizen and beloved associate, DR. JOSEPH 
PARRISH, the following resolutions were unanimously adopted: 

Resolved^ That this Board have received with deep emotion, the painful intelli- 
gence of the demise of their much esteemed and lamented fellow member. Dr. 
Joseph Parrish. 

Resolved^ That being fully sensible of the worth of their deceased colleague, 
and of the valuable services he has rendered to this institution since its first 
organisation — during the whole of which period he has been called upon to pre- 
side over the deliberations of this Board — we do now direct to be recorded upon 
the minutes this expression of the high esteem in which his surviving associates 
have ever held the virtues, talents, and public usefulness of the deceased, and 
the deep regret they experience for his loss, as a valuable member of this Board, 
an enlightened Philanthropist, a distinguished Physician, and a sincere and con- 
sistent Christian. 

Resolved., That we deeply sympathise with the family and relatives of the 
lamented deceased in their severe affliction: and that the Secretary of this Board 
be requested to transmit to them a copy of these resolutions, with a letter express- 
ing, on behalf of his colleagues, their sincere condolence with them, on this 
their melancholy bereavement. 

Resolved., That when we adjourn, it will be to meet at the late residence of 
the deceased, at the hour appointed for his funeral, and that we attend the same 
in a body. FREDERICK ERRING ER, President, pro tern. 

M. C. Shallcross, Secretary. 

At a special meeting of the Philadelphia Medical Society, held on the 19th 

American Intelligence. 259 

of March, 1840, the Vice President Professor S. Jackson being in the chair, the 
following preamble and resolutions were adopted: — Whereas, 

It appears to be proper to this society that upon the decease of an eminent 
member of this body, some expression of the sentiments of his remaining 
brethren upon the occasion should be made public; and, whereas, it hath pleased 
the Divine Providence to remove from this world our late esteemed and beloved 
member JOSEPH PARRISH, M. D., it is therefore, 

Resolved^ That we have heard with profound regret of the decease of that emi- 
nent physician, whose professional skill, humanity, and liberal, and just con- 
duct, have long endeared him to us and to the profession at large in this city. 

Resolved^ That we deplore the loss of a physician, whose long career in the 
practice of his art, has been distinguished by the most brilliant success, accom- 
panied by a modesty and ingenuousness of conduct, which secured to him the 
affectionate attachment of the medical profession in this city, as well as their 
highest respect. 

Resolved^ That a member of this Society be requested to prepare and deliver 
before this body, a biographical account of the deceased, in order that, although 
his present and living example has ceased from among us, some permanent 
memorials may be secured, of a life which hath been highly useful to the medi- 
cal body, by a pure example of morals; by great attainments in medicine and 
surgery, and by a rare moderation lit to be preserved as the model of a wise, 
benevolent and upright physician. 

Resolved^ That the members of the Society wear crape on the left arm for 
thirty days as a testimony of their feelings, as expressed in the foregoing reso- 

Resolved^ That the members of the Society will attend the funeral of the 
deceased, to-morrow afternoon, at three o'clock, and that we hereby invite the 
physicians of this city, to meet with us at our Hall, in order to join with us in 
the manifestation of due respect to the deceased. 

Resolved^ That a committee of three members be appointed to present a copy 
of these resolutions to the family of the deceased. 

C. D. Meigs, M. D., R. Coates, M. D., and Caspar Morris, M. D., were then 
appointed a committee to carry into effect the object of the last resolution. 

On motion of Dr. C. Morris, seconded by Dr. West, 

Resolved, That Dr. Geo. B. Wood be respectfully requested to prepare the 
memoir contemplated in the above resolutions. 

On motion of Dr. T. S. Kirkbride, 

Resolved, That an account of the proceedings of this meeting be published in 
the medical periodicals of this city, and in the city morning papers of to-morrow. 
EDWARD HARTSHORNE, Jun. Recording Secretary, 

At a meeting of the former pupils of the late Dr. Joseph Parrish, held at the 
hall of the Medical Society, on the 21st of March, 1840, Professor Wood was 
called to the Chair, and Dr. Norris appointed Secretary. 

The following resolutions, offered by Professor Morton, were adopted; 

Resolved, That we contemplate with feelings of unfeigned sorrow the demise 
of our venerated friend and preceptor, Joseph Parrish, M. D. 

Resolved, That we regard the death of this estimable man as a severe loss, not 
only to the medical profession but to the community at large, and above all to 
ourselves, who have been instructed by his precepts and fostered by his kindness. 

Resolved, That an intimacy of many years continuance has tended more and 
more to enhance our esteem for his many virtues, his amiable manners, and his 
professional skill. 

Resolved, That a copy of these resolutions be presented to the family of Dr. 
Parrish, with the assurance of our sincere sympathy for the afflictive bereave- 
ment they have suffered in his death. 

Professor Morton, and Dr. Yardly were then appointed a committee to carry 
into effect the last resolution. 
On motion of Dr. Yardly, it was 

Resolved, That this meeting cordially unite with the Medical Society, in the 

260 American Intelligence* 

appointment of Professor Wood (one of our number) to prepare a biog-raphical 
memoir of our lamented perceptor; believing' that he will do full justice to his 
superior ability as a teacher of medicine and surgery, as well as portray his 
exalted and endearing character as a physician, his worth as a man, and his 
virtues as a Christian. 

Resolved^ That we will in a body attend the reading of said memoir at such 
time and place as Dr. Wood, and the Medical Society may select. 

On motion of Dr. West, 

Resolved, That the proceedings of this meeting, be published in the medical 
periodicals and newspapers of the city. GEO. W. NORRIS, Secrdary. 

Extract from the minutes of a meeting of the Philadelphia College of Physi- 
cians, held on the 7th of April, 1840. 

"The President announced the death of Dr. Joseph Parrish, the Vice Presi- 
dent of the college, which occurred on Wednesday morning, March 18th at 9 
o'clock; whereupon Dr. Condie offered the following resolutions, which were 
unanimously adopted. 

Resolved, That the College deeply deplores the loss it has sustained, by the 
death of its late venerated Fellow and Vice President Dr. Joseph Parrish. 

Resolved, That Dr. George B. Wood, be respectfully requested to present to 
the College, a notice of the life and character of the deceased." 

HENRY BOND, Secretary. 

At a meeting of the Pathological Society of Philadelphia, held on the 30th of 
March, 1840, the following resolutions were adopted: 

Resolved, That the Pathological Society, have learned with deep regret the 
demise of their respected associate member. Dr. Joseph Parrish, whose philan- 
throphy, and devotion to the science of medicine, have for so many years com- 
manded the high respect and regard to the members of his profession, and will 
ever be remembered by them with the liveliest gratitude. 

Resolved, That the Society highly appreciate the importance of the directions 
given by Dr. Parrish, that his body should be examined, believing that the 
example is one which is eminently conducive to the advancement of the science 
of medicine, and to the deepest inserests of humanity, G. W. NORRIS, Sec. 

Complimentary Resolutions to Dr. W. W. Gerhard. — [We take pleasure in 
giving a place to the following communication. Of the value and importance 
of clinical instruction, but one opinion can be entertained, and from what we 
know of the zeal, talents and acquirements or Dr. Gerhard, we are sure that the 
compliments conveyed in the resolutions are entirely merited.] 

A portion of the medical class of the University of Pennsylvania, who have 
attended the lectures at the Philadelphia Hospital, being desirous of expressing 
their sense of the value and importance of clinical instruction, and of their obli- 
gations to Dr. W. W. Gerhard, for the able course of Lectures delivered by him 
at that institution during the present session, have met together for that purpose. 

Resolved 1st, That we consider clinical instruction the most important method 
of teaching the pathological states of the system, and of familiarising the mind 
of the student with the means of correcting the aberrations from the standard of 

2d. That we consider the course of lectures, now being delivered on clinical 
medicine at the Philadelphia Hospital of great value, particularly because of 
the truly scientific, as well as practical manner in which diseases involved in 
much obscurity, are elucidated. 

3d, That we consider Dr. Gerhard emrainently qualified to give instruction 
in clinical medicine and pathological anatomy, and that we particularly admire 
his unequalled skill in illustrating the diseases of the thoracic organs. 

4th, That a committee of ten be appointed to present a copy of these resolu- 
tions to Dr. Gerhard, and to tender him our thanks for the zeal and ability, 
which he has manifested in the interests of the class. 

American Intelligence. 


bth, That these resolutions be signed by the Chairman and Secretary, and 
that a copy of them be presented to the faculty throug-h their dean. 

6/A, That a copy of these resolutions be also sent to the Medical Journals 
and newspapers of this city, with a request that they publish them. 

The Committee appointed under the fourth resolution consists of the follow- 
ing Gentlemen: — Drs. C. Quarlesand R. Kownselar, and Messrs. T. B. Lamar, 
M. A. Page, T. R. Spencer, W. H. Van Buren, Allen Gunn, H. Selden, T. L. 
Walker, and J. R. Justice. On motion the Chairman and Secretary w^ere 
added to the committee. J. A. PLEASANTS, M. D. Chairman, 

L. S. JOYNES, M. D. Secretary. 

University of Pennsylvania. — The matriculants in the Medical Department at 
the past Session numbered 444; of whom there were from Alabama 24, British 
Provinces 2, District of Columbia 2, Delaware 7, Georgia 17, Ireland 2, Illinois 
1, Indiana 2, Kentucky 2, Louisiana 5, Maryland 12, Mississippi 7, Missouri 3, 
New England 8, New Jersey 18, New York 12, North Carolina 63, Ohio 6, 
Pennsylvania 44, Philadelphia 55, South Carolina 9, Tennessee 29, Virginia 
111, West Indies 1, England 2. 

At a Public Commencement, held April 3d, 1840, the Degree of Doctor of 
Medicine was conferred upon the following gentlemen. 




Addison, Kendall F. 


General Inflammation. 

Aldredge, James F. 


Intermittent Fever. 

Allen, John M. M. 



Anderson, Edward H. 

South Carolina, 


Anderson, Robert M. 


Effects of civic life. 

Anderson, WilliBm W. 



Barksdale, Randolph B, 



Barr, John A. 



Barry, Thomas 



Battle, Thomas W. 


Yellow Fever. 

Baum, Andrew D. 



Benedict, Nathan D. 

New York, 

Mineral waters. 

Binford, Walter L. 


Gun-shot wounds. 

Blow, William James 

North C'arolina, 

Acute Rheumatism, 

Bolton, Charles 


Compression of the Brain. 

Booth, William A. 



Brent, Thomas S. 

North Carolina, 


Brings, John Robert 


Pneumonia Biliosa. 

Bryan, Joseph Rhodes 



Bryan, William T. 

North Carolina, 


Byrne, Patrick Henry 


General Treatment of Intermittent 
and Remittent Fevers. 

Cauthorn, Lucius H. 



Chaloner, Aaron D. 


The best mode of detecting poison- 
ing by arsenic. 

Childers, Erasmus R. 



Christian, James R. 



Cole, Meriwether H. 



Cole, William 



Cooper, Lewis D. 

North Carolina, 


Crawford, John J. 


Traumatic Hemorrhage, and its 
means of arrestation. 

Currey, Richard 0. 



Curtis, Charles F. 


Medicine as it flourished in Arabia. 

Day, J. Lawrence 

New Jersey, 

Counter irritants as remedial agents. 

Delany, P. Benson 


Physiological effects of atmospheric 

Doggett, John B. 

North Carolina, 


Donnally, John J. 


Acute Hepatitis, 

Dulaney, Abraham G. 



Dunlap, Joseph B. 


The means of arresting Hemorrhage* 


American Inlelliorence. 


Edraondson, William J. 

Eppes, Benjamin F. 
Faulkner, Leandcr 
Featherston, Edwin C. 
Feild, Richard Dunn 
Flanner, Thomas J. 
Gamble, James H. 
Garrett, Richard W. 
Gee, Luras 
Glass, Robert 
Griswuld, Alexander S. 

Gunn, Allen 
Hamner, Austin M. 
Hardy, Benjamin F. 
Harrison, George M. 
Harrison, John H. 
Hartshornc, Edward 
Hastings, John 
Headcn, Isaac B. 
Herndon, Dabney 
Heterick, Alexander B. 
Hicks, Benjamin I. 
Inge, Richard J. 
Irwin, William T. 
Jackson, William W. 
Jennings, Robert M. 
Johnson, William Q. (M.D.) 
Joaes, George F. 
Joyner, Noah 
Justice, John R. 
Kenney, William H. 
King, Nathaniel M. 
Lake, Thomas 
Lamar, Thomas B. 
Lang, Edmund 
Lawson, Mordecai 
Learning, Coleman F. 
Lewis, Elisha J. 
Lewis, John E. 
Lindsay, William D. 
Lippincott, Franklin 
Lyman, J. Huntington, 
Martin, William F. B. 
Marye, James B. 
Mather, George 
Miller, Jos. HoUingsworth 
Miller, Joseph S. 
Morrill, Henry Edwin 
Morris, Barton W. 
Morton, John Watson 
MuUer, William H. 
Murphy, George W. 
M'Cain, James W. 
M'Cartee, Divie Bethune, 
M'Coy, Gilbert R. 
M'Dowell, Augustus W. 
M'Kee, William H. 
M'Lane, George R. 
M'Pheeters, William M. 
Neal, Ebenezer 
Neill, John 


Virginia, Influence ot mental emotions in the 
prf)duction and cure of disease. 

Virginia, Scarlatina. 

Virginia, Congenital Hydrocephalus. 

Tennessee, Caries of Spine. 

Virginia, Variola Vaccina. 

North Carolina, Scarlatina. 

Ireland, Onanism. 

Alabama, Mammary Abscess. 

Mississippi, Carbon. 

Tennessee, Anatomy & Physiology of the Liver. 

Michigan, Difference between Apoplexy and 
Narcotic poisoning. 

North Carolina, Abortion. 

Tennessee, Cholera Infantum. 

Philadijlphia, Delirium Tremens. 

Illinois, Chylopoietic derangement. 

Mississippi, Otitis Interna. 

Philadelphia, Pseudarthrosis. 

Philadelphia, Fractures of the Extremities. 

North Carolina, Acute Dysentery. 

Virginia, Urinary Calculi. 

Virginia, Tetanus. 

Virginia, Tubercles in the Brain. 

Alabama, Cholera Infantum. 

Virginia, Cynanche Laryngea. 

Alabama, Menstruation. 

Virginia, Pathology of the Cellular Tissue. 

Virginia, Asiatic Cholera. 

Tennessee, Dysmenorrhcea. 

North Carolina, Rubeola. 

North Carolina, Acute Dysentery. 

Pennsylvania, Intermittent Fever. 

Maryland, Scrofula. 

South Carolina, Etiology and Pathology of Dropsy. 

Georgia, Blood-letting. 

New York, Iritis. 

Virginia, Colica Biliosa. 

New Jersey, Hybernation of animala. 

Philadelphia, Tubercles 

Georgia, Bilious Remittent Fever. 

North Carolina, Counter Irritation. 

New Jersey, Intermittent Fever. 

Massachusetts, Paralysis. 

Virginia, Epilepsy. 

Virginia, Variola. 

Louisiana, Asiatic Cholera. 

Ohio, Milk-sickness. 

North Carolina, Coxalgia. 

Ohio, Formation of Medical Character. 

Virginia, Curvatures of the Spine. 

Tennessee, Gonorrhoea. 

Pennsylvania, Nervous system. 

Indiana, Milk-sickness. 

North Carolina, Neuralgia. 

Pennsylvania, V^ariola. 

Pennsylvania, Metastasis, 

Philadelphia, Jaundice. 

Philadelphia, Diabetes. 

Delaware, Hernia. 

North Carolina, Scrofula. 

Philadelphia, Typhus Fever. 

Philadelphia, Diseases of the Eye. 

American Intelligence. 



Nelson, Robert C. 
Newbold, Georjsfe L, 
Norris, James 
Park, John S. 
Patton, William N. 
Pawsey, George 
Payne, Richard A. 
Percy, John W. 

Perry, John C. 
Pettus, John R. 
Powell, Jesse C. 
Pugh, Joseph H. 
Purdom, James A. L. 
Rawlings, Georg-e C. 
Ravvson, La Quinio 
Read, Adolphus W. 
Reilly, Thomas A. 
Roberts, John W. 
Roberts, William 

Rowland, Joseph 
Sangster, Alexander J. 
Scruggs, Robert A. 
Seal, Charles L. 
Shelly, William A. 
Shelton, Thomas D. 

Shelton, John D. 
Sheppard, John M. 
Simpson, Richard F. 
Smart, Burleigh 
Smiley, Alexander H. 
Smith, Francis G. Jr. 
Smith, James C. 
Smith, Samuel M. 
Smith, Samuel T. 
Smith, Solomon W. 
Spencer, Thomas R. 
Stearns, Charles W. 
Stocker, Anthony E. 
Stokes, Young C. 
Stout, Josiah W. 
Swoope, William M, (M.D.) 
Taylor, Arthur K. 
Taylor, William J. 
Terrell, John C. 
Thomas, William G. 
Thompson, Foster H. 
Thompson, John 
Thorp, William 
Trexler, Lesher 
Van Bnren, William H. 
Van Deursen, John H. 
Walker, Anselm N. 
Walker, James Alexander 
Walker, Thomas L. 
Weaver, James 
Wilkins, Alexander M. 
Williams, James L. 
Womack. James G. 
Womack, William B. 
Woodley, Thomas (M. D.) 


Virginia, Continued Fever. 

New Jersey, Dyspepsia. 

Virginia, Acute Peritonitis. 

Tennessee, Cachexia Africana. 

Virginia, Menorrhagia. 

England, Fistula Lachrymalis. 

Virginia, Intermittent Fever. 

Alabama, General and Pathological Anatomy 

of the Arteries. 

North Carolina, Croup. 

Virginia, Acute Hepatitis. 

North Carolina, Acute Dysentery. 

Louisiana, Acute Hepatitis. 

Alabama, Pulmonary Tubercles. 

Virginia, Irritable Uterus. 

Ohio, Intermitting Fever. 

Virginia, Scarlatina. 

Philadelphia, Cholera Infantum. 

Virginia, Acute Gastritis. 

New York, Abscess and tendency of pus to the 


Pennsylvania, Tetanus. 

Virginia, Variola. 

Virginia, Acute Hepatitis. 

Pennsylvania, Trachitis. 

Pennsylvania, The congenital club-feet of children. 

Virginia, Surgical means of suppresing He- 

New York, Effects of Malaria. 
Virginia, Dysentery. 
Virginia, Dysenteria Acuta. 
Maine, Scrofula. 
Tennessee, Apoplexy. 
Philadelphia, Delirium cum Tremore. 
North Carolina, Delirium Tremens. 
Ohio, Blood-letting as a Diagnostic. 
New York, Hydriodate of Potassa. i 
Virginia, Pneumonia Biliosa. 
New York, Typiiiod Fever. 
Massachusetts, Eclecticism in Medical Science. 
Philadelphia, Osteology. 
Mississippi, Acute Hepatitis. 
Tennessee, Veratria. 
Virginia, Modus Operandi of Poisons. 
Tennessee, Verminous Affections. 
New Jersey, Hydrophobia. 
North Carolina, Cholera Infantum. 
North Carolina. Unavoidable Uterine Hemorrhage- 
Alabama, Fracture of the Clavicle. 
North Carolina, Trachitis. 
North Carolina, Secale Cornutum. 
Pennsylvania, Vaccination. 
Philadelphia, Immoveable Apparatus. ' 
New Jersey, Burns. 
Georgia, Spinal Neuralgia. 
Kentucky, Scarlatina. 
Virginia, Serous Tissues. 
Tennessee, Animal Heat. 
Alabama, Typhus Fever. 
Alabama, Congestive. 
North Carolina, Bilious Congestive Fever, 
Tennessee, Pleuritis. 
Virginia, Sthenic Pneumonia. 

264 American Intelligence. 


Woodson, W. Moncare Virginia, Scarlatina 

At the commencement, held July, 1839, the Degree of M. D. was conferred on 


Alexander Archer, Virginia, Acute Dysentery. 

Charles Kershaw, South Carolina, Intermittent Fever. 

William Augustus Newell, New Jersey, Glossitis. 

William Y. Pratt, South Carolina, Acute Rheumatism. Total, 163. 

Transylvania University. — The number of students in the medical department 
during the past session was 257; of whom there were from Kentucky 117, 
Tennessee 35, Alabama 25, Georgia 13, South Carolina 10, Mississippi 12, 
Indiana 8, Missouri 7, Ohio 7, Virginia 5, North Carolina 3, Illinois 3, Penn- 
sylvania 3, Louisiana 2, Maryland 1, Michigan 1, Wisconsin 1, Alabama 1, 
Texas 1. 

At a public commencement held I4th March, 60 were graduated doctors in 
medicine, and at the same time the honorary degree of M. D. was conferred on Dr. 
Samuel K. Sharpe of Maysville, Kentucky, and Dr. J. C. Williams, of New 

Medical College of the State of South Carolina. — There were one hundred and 
ninety-three students in attendance on the lectures in this school, during the 
past session. Of these there were from South Carolina 133, Georgia 32, North 
Carolina 14, Alabama 11, Mississippi 2, Virginia 1, Florida 1. 

At the termination of the course, the degree of M. D. was conferred on 63. 

Medical Institute of the city of Louisville. — At session 1839 — 40, number of 
students 204; of whom were from Kentucky 67, Tennessee 48, Alabama 24, 
Indiana 18, Mississippi 15, Illinois 9, Missouri 7, Ohio 7, Virginia 3, Louisi- 
ana 1, Georgia 1, South Carolina 1, North Carolina 1, District of Columbia 1, 
England 1. 

Medical Institution of Geneva College. — Session 1 839 — 40. Number of students 
81; graduates 19. 

New Work preparing for Publication. — We learn that Messrs. Lea & Blan- 
chard will re-publish the LIBRARY OF MEDICINE, conducted by Dr. 
TwEEDiE, with the assistance of numerous contributors of known and acknow- 
ledged abilities. This series will treat of each department or division of me- 
dicine in separate volumes; each series forming a complete work on the subject 
treated of, and to be authenticated by the name of the author. 

This work is to be issued in London, and as fast as received in this country 
it will be placed in the hands of competent persons for revision, and such ad- 
ditions, or notes, as the works may require. It will be printed in a cheap form, 
so that any work or treatise can he had separately. 

The first volume oTthe first series. Practical Medicine, will soon be ready. 
Contents of Vol. I. — Pathological Introduction. — Dr. Symonds. 
Part I. — Inflammation. — Dr. Alison. 

Part II. — Fevers: General Doctrines of Fevers. — I. Primary Fevers. — 1. Con- 
tinued Fever — Synocha, or Inflammatory Fever— Synochus, or Mixed Fever 
^^Typhus, or Adynamic Fever. — Dr. Christison. — Plague. — 2. Intermittent 
Fever — Tertian — Quotidian — Quartan. — '3. Remittent Fever — Marsh Remit- 
"tent — Yellow. — Dr. Shapter. 

II. Irritative Fevers. 

Gastric Remittent Fever of Children. — Dr. Locock. 
Hectic Fever. — Dr. Christison. 

III. Eruptive Fevers. 

Small Pox and Vaccination. — Dr. Gregory. 
Measles — Scarlet Fever. — Dr. G. Burrows. 






, THE 







Each number contains 260 pages, or upwards, and is frequently illustrated by co- 
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Persons sending Twenty Dollars will be entitled to five copies of the work, to be 
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The postage per number is, within 100 miles, about 16 cents; over 'lOO miles, 
about 28 cents. 

A few complete sets may be had\ at a large discount from the subscription price. 
Odd numbers can be furnished to complete sets. 

of ouWditnrial dinies."-— " Our copious extracts from 
hi.s unequalled publication, uniioticing multitudes of 
others vvliicli come before us, are the best proof of the 
esteem which we entertain for his talents and 
abilities." — London Medical avd Surgical Journal 

" The Medical Journal of Medical Sciences is one 
of the most complete and best edited of the numerous 
periodical publications of the United Slates." — Bui- 
Ictan des Sciences Medicates, tome xiv. 

" The Medical Journal of iMedical Sciences is con- 
ducted with distinguished ability. Published in one 
of the most literary cities in our country, and sup- 
ported by a number of her int>st gifted and besit 
educated physicians, its reputation isdeservedly high 
as well abroad as at home." — Transylvania Joui nal. 

The following Extracts sliow the estima- 
tion in which the Journal is held. 

"Several of the American Journals are before us. 
* * * Of these, the American Journal of the Medical 
Sciences is by far the better periodical; it is, indeed, 
the best of the trans-atlantic medical publications; 
and, to make a comparison nearer home, is in must 
respects superior to the great majonly of European 
works of the same description." — 77ie London Lancet. 

"We need scarcely refer our esteemed nod highly 
etninent contempory, [The American Journal of Me- 
dical t^ciences,] from, whom we quote, to our critical 
remarks of the opinions of our own countrymen, or 
to the principles which influence us in the dischaige 

AND PHARMACY, By H. M. Edwards, 
M. D. and P. Vavasseur, M. D. 

struction to Students on the Methods of 
performing Experiments of Demonstration 
or Research, with accuracy and success. 
By MicrtAEL Farriday, F. R. S. First 
American, from the second London edition, 
with additions by J. K. Mitcuell, M. D. 

with 108 coloured Plates. By W. P. C. 
Barton, M. D. In 3 vols. 4to. 



By Professor Gibson. (In preparation.) 

RISPRUDENCE. By Professor R. 
E. Grifiith. In one volume. (Now 

OF MEDICINE. By professor Dung^li- 
son. In two volumes, octavo. (In prepa- 



A NEW di£;tionary, 


3MCSDZ0AI. scinncE ANB z.:ti:rature. 


Completely Revised, with Numerous Additions and Improvements, 






A concise account of the various Subjects and Terms, with a vocabulary of Syno- 
nymes in different languages, and formulte for various officinal and empirical pre- 
parations, &LC. 


" The present undertaking was sug- ference he can have." — London Medical 

gGsted by the frequent complaints, made 
by the author's pupils, that they were un- 
able to meet with information on numerous 
topics of professional inquiry,— especially 
of recent introduction, — in the medical dic- 
tionaries accessible to them. 

It may, indeed, be correctly affirmed, 
that we have no dictionary of medical sub- 
jects and terms which can be looked upon 
as adapted to the state of the science. In 
proof of this the author need but to remark, 
that he has found occasion to add several 
thousand medical terms, which are not to 
be met with in the only medical lexiRn at 
this time in circulation in the country. 

The present edition will be found to 
contain many hundred terms more than 
the first, and to have experienced nunierous 
additions and modifications. 

The author's object has not been to make 
the work a mere lexicon or dictionary of 
terms, but to aflford, under each, a condensed 
view of its various medical relations, and 
thus to render the work an epitome of the 
existing condition of medical science." 

'* To execute such a work requires great 
erudition, unwearied industry, and exten- 
sive research, and we know no one who 
could bring to the task higher qualifications 
of this description than Profe.<sor Dungli- 
eon." — American Medical Journal. 

"This is an excellent compilation, and 
one that cannot fail to be very much re- 
ferred to. It is the best medical lexicon in 
the English language that has yet appeared. 
We do not know any volume which con- 
tains 80 much information in a small com- 
pass. The Bibliographical notices, though 
so short, are very important and useful ; and 
altogether we can recommend to every 
medical man to have this work by him, as 
the cheapest and best dictionary of re- 

and Surgical Journal. 

" So far as we have been able to examine 
this Dictionary, it is exceedingly thorough 
and correct, not only in matters purely 
medical, but in whatever can fairly be ar- 
ranged in the various branches of science, 
collateral or con tributary to Medicine and i 
Surgery," — Medical Magazine. * 

" So well known are the merits of this 
valuable work, that, in noticing a second 
edition of it, it will suffice to extract the 
remark of the author in the preface, *that ^ 
it will be found to contain many hundred 
terms more than the first, and to have ex- 
perienced numerous additions and modifica- 
tions.' It has been got up by the publishers 
in very handsome style, and must command, 
as it deserves, an extended circulation." — 
Medieval Examiner. 

"It is wholly unnecessary, we appre- 
hend, to enter into a long or formal state- 
ment of the fact, that Dr. Dunglison's Dic- 
tionary, from the first day of its appearance, 
has been regarded with peculiar favour. - 
And we have now a revised edition, con- 
structed under the immediate eye of the au- 
thor, who is most favourably circumstanced 
for adding to the previous edition what- 
ever could give it additional claims on the 
score of accuracy. Here are eight hundred 
and twenty-one pages, large octavo, in 
double colums, distinct type, of which no 
one ought to complain. Finally, although 
most of our readers may be owners of the 
first edition, wo cordially and conscientious- 
ly recommend to all future purchasers to 
procure this in prefejrence to any medical 
lexicon extant. Its true and sterling value, 
as a key to medical science, and its mode- 
rate price, are so many common-sense re- 
commendations which should not be for- 
gotten. "- 

■Boston Medical and Surgical 







The JMethod of I^reparmg S>* Jldministering them; 




Professor of the Institutes of Medicine and Materia Medica in Jefferson Me- 
dical College of Philadelphia; Attending Physician to the Philadelphia 
Hospital, <^c. 

" The value of this book is hardly to be , practitioners. It is creditable to the in- 
estimated; to be without it, would be very jdustry and wise discrimination of the au- 
iriuch like obstinacy, and amount to the j thor, and quite necessary to the libraries 

same thing- as saying-, like tlie Austriabs in 
regard to their government, nothing can be 
improved, for we already live in a state of 
p'erfection. Dr. Dtsnglison, the author, has 
done an essential service to all classes of 

of those who feel the necessity of keeping 
pace with the improvements and discoveries 
in the broad but imperfectly exploded do- 
main of meidicine." — Boston Medical and 
Surgical Journal. 

Jl Third Edition, Improved and Modified, of 



Illustrated With Numerous Engravings. 

" We are happy to believe that the rapid 
sale of the last edition of this valuable work' 
may be regarded as an indication of the ex- 
tending taste for sound physiological know- 
ledge in the American schoolsl and what 
we then said of its merits, will show that 
we regarded it as deserving the reception 
it has experienced. Dr. Dunglison has^ 
we are glad to perceive, anticipated the 
recommpndatiorl v/hich we gave in regard 
to the addition of references, and hag'there- 
by not only added very considerably to the 
val'uei of his work, but has shown an extent 
of reading which, we confess, we were not 
prepared by his former edition to expect. 
He has also availed himself of the addi'- 
tional materials supplied by the works that 

have been published in the interval, espe- 
cially those of MiiUer and Burdach. So 
that as a collection of details on human 
physiology alone, we do not think that it is 
surpassed by any work in our language: 
and we can recommend it to students in 
this country (England) as containing much 
with which they will not be likely to meet 
elsewhere." — British and Foreign Medi- 
cal Review. 

This work exhibits another admirable 
specimen of American industry and talent, 
and contains an account of every discovery 
in Europe uJ3 to the period of a \ew months 
prior to >ts publication. Many of the au- 
thor's views are original and important.'" — 
Dubliii Journal of Medieal Sciences. 






With Tables of the Chief Remedial Agents and their Preparations, and of the 
Different Poisons and their Antidotes. 

Bif Robert Dunglison, M. D.^ &c., &c. 

One Volume, large 8vo. 

"There being- at,.present before the public several American works on Therapeutics, 
written by physicians and t^aChers of distinction, it might be deemed vmjust in us, and 
would certainly be invidious, to pronounce any of tiiem superior to the otliers. We shall 
not, therefore, do so. If there be, however, in the English language, any work of the 
kind more valuable than that we have been examining, its tide is unknown to us. 

"We hope to be able to give such an account of the work as will strengthen the desire 
and determination of our readers to seek for a farther acquaintance with it, by a candid 
perusal of the volume itself. And, in so doing, we offer them an assurance that they will 
be amply rewarded for their time and labour." — Transylvania Journal^ Vol. IX, No. 3. 

to the Study ^ of Medicine. IncludiHg a 
Glossary of the Terms of the Science, and 
of the Mode of Prescribing; Bibliographical 
Notices of Medical Works; the Regula- 
tions of, the Different Medical Colleges of 
of the Union, &e. By Robley Dunglison, 
M. D., &c., &c. In one volume, 8vo. 

Influence of Atmosphere and Locality; 
Change of Air and Climate, Seasons, Food, 
Clothing, Bathing, Sleep, Corporeal and 
Intellectual Pursuits, &c., on Human 
Health, Constituting Elements of Hygiene. 
By Robley Dunglison, M. D. &c., &lc. In 
1 vol. 8vo. 




Subjects Embraced in the Articles from Ji to Azote, p-fiejmred for the Cyclo- 
pedia of Practical Medicine by 

Dr. Chapman, 
Dr. Jackson, 
Dr. Horner, 
Dr. Hodge, 
Dr. Wood, 

Dr. Dewees, 
Dr. Hays, 
Dr. Dunglison, 
Dr. Mitchell, 

Dr. Bache, 
Dr. Coates, 
Dr. Condie, 
Dr. Emerson, 
Dr. Geddings, 

Dr. Griffith, 
Dr. Harris, 
Dr. Warren, 
Dr. Patterson, 

Each article is complete within itself, and embraces the practical experience of its- 
author, and as they are only to be had in this collection will be found of great value to 
the profession. 

*^* The two volumes are now offered al: a price so low, as to place them within tii* 
reach of every practitioner and student. , 





of a Course of Lectures. By William Gibson, M. D., Professor of Surgery in 
^h| University of Pennsylvania, &c. &c. Fifth edition, greatly enlarged. In 2 
vols. 8vo. With thirty plates, several of which are coloured. 

" The author has endeavoured to make this edition ns complete as possible, by 
adapting it to the present condition of surgery, and to supply the deficiencies of former 
editions by adding chapters and sections on subjects not hitherto treated of. And, 
moreover, the arrangement of the v^^ork has been altered by transposing parts of the 
second volume to the first, and by changing entirely the order of the subject in the 
second volume. This has been done for the purpose of making the surgical course 
in the university correspond with the anatomical lectures, so that the account of sur- 
gical diseases may follow immediately the anatomy of the parts." 


prising most of the diseases not treated 
of in Diseases of Females and Diseases 
of Children. By W. P. Dewees, M. 
D., formerly adjunct professor in the 
University of Pennsylvania. In one 
volume, octavo. 


By Dr. Dewees. 

Chiefly designed to facilitate the Inqui- 
ries of those who may be pursuing this 
branch of Study. Illustrated by occasional 
cases and with many plates. The ninth 
edition, with additions and improvements. 
In one vol. 8vo. 



The seventh edition, Revised and 
Corrected. With additions, and Nu- 
merous plates. In one vol. 8vo. 

With Corrections and Improvements. 
The seventh ed. In one volume, 8vo. 

The objects of this work are, 1st, to teach 
those who have the charge of children, ei- 
ther as parent or guardian, the most ap- 
proved methods of securing and improving- 
their physical powers. This is attempted 
by pointing out the duties which the parent 
or the guardian owes for this purpose, to 
this interesting but helpless class of beings, 
and the manner by which their duties shall 
be fulfilled. And 2d, to render available a 
long experience to these objects of our af- 
fection when they become diseased. In at- 
tempting this, the author has avoided as 
much as possible, "technicality;" and has 
given, if he does not flatter himself too 
much, to each disease of which he treats, 
its appropriate and designating characters, 
with a fidehty that will prevent any two 
being confounded together, v/ith the best 
mode of treating them, that either his own 
experience or that of others has sugoestcd. 


A Treatise on Special and General Anatomy. By W. E, 
sor of Anatomy in the University of Pennsylvania, &c. &c. 
and much improved. In two volumes, 8vo. 

Horner, M. D,, Profes- 
Fifth edition, Revised, 




The Medical Formulary, being a collec- 
tion of prescriptions derived from the writ- 
ings and practice of many of the most emi- 
nent Physicians in America and Europe. 
To which is added an appendix, containing- 
the usual Dietetic preparations and Anti- 
dotes for Poisons, the whole accompanied 
with a few brief Pharmacuetic and Medi- 
cal observations. By Benjamin Ellis, M. 
D., Fifth edition, witlj additions. In one 

Broussais on Inflammation, 2 vols. Svo. 

Broussais' Pathology, 1 vol. Svo. 

Colles' Surgical Anatomy, 1 vol. 8vo. 

Costers' Physiological Practice, 1 vol. 

Greys' Chemistry applied to the Arts, 
2 vols, with numerous plates. 

independently of TECHNICAL MA- 
THEMATICS, and containing New 
Disquisitions and Practical Suggestions. 
By Neil Arnott, M. D. In two 
volumes, octavo. 

" Dr. Arnott's work has done for Physics 
as much as Locke's Essays did for the 
science of mind." — London University 

" We may venture to predict that it will 
not be surpassed." — Times. 

" Dr. A. has not done less for Physics 
than Blackstone did for the Law." — Mvrn^ 
ing Herald. 

"Dr. A. has made Natural Philosophy 
as attractive as Buffonmade Natural His- 
tory." — French Critic. 

" A work of the highest class among the 
productions of mind." — Courier. 





BY P. M. ROGET., M. D. 

Professor of Physiology in the Royal Institute of Glreat Britian, &c. &c. 


Revised, with numerous notesj 

In one volume, 8vd; 

From the Amefican fefacJe.— " Of the 
the Author's qu'alificatiofisas a physiological 
writer it is scarcely requisite to speak. 
The fact of his having been selected to com- 
pose the Bl-idge water Treatise dn Anirhal 
and Vegetable Physiology, is sufficient evi- 
dence of the reputatidn which he then en- 
joyed; and the rhode in which he executed 
the task amply evinces that his reputation 
rested on a solid basis. 

"The present volume contains a con- 
cise, well-written epitome of the present 
state of Physiology— human and compara- 
tive — not, as a matter to be expected, the 
copious details and developments to be met 
with in the larger treatises on the subject; 
but enough to serve as an accompaniment 
and guide to the physiological student. 

"The attention of the American Editor 
has been directed to the revision and cor- 
rection of the text; to the supplying, in the 
form of notes, of omissions; to the rectifi- 
cation of some of the points that appeared 

to him erroneous or doabtful, and to the fur- 
nishing of references to works in which the 
phy-sioiogical inquirer might meet with 
more ample information. 

" In Phrenology, the Author is a well- 
known unbeliever, and his published ob- 
jections tb the doctrine have been regarded 
as too cogent to be permitted to pass un- 
heeded. It will be seen on farther exami- 
nation in the interval of many years, which 
has elapsed since the publication of the 
sixth edition of the Encyclopaedia, has nofe 
induced him to modify his sentiments ori 
this head. On the contrary, he appears to 
be as satisfied at this time, of the fallacy of 
the positions of the Phrenologist, as he was 
at any former period."' 

O^This work will be introduced into 
many of the Medical Colleges of the union 
as a Text Book, it being a cheap volume^ 
and well fitted as an introduction to the' 
larger works on Physiofogy. 







Consisting of outlines of Anatomy, Physiology, and liycnene, with 
such Hints on the Practice of Physic, Surgery, and the Diseases of 
Wonfien and Children, as naay prove useful in families when regular 
Physicians cannot be procured : Being a Companion and Guide for in- 
telligent Principals of Manufactories, Plantations, and Boarding Schools; 
Heads of Families, Masters of Vessels, Missionaries, or Travellers, and 
a useful Sketch for Young Men about commencing the Study of Me- 


Fellow of the College of Physicians of Philadelphia— Honorary Member of the 
Philadelphia Medical Society— Correspondent of the Lyceum of Natural History 
of New York— Member of the Academy of Natural Sciences of Philadelphia— Former- 
ly Resident Surgeon of the Pennsylvania Hospital, &c. 

Assisted by several Medical friends. In One Volume. 

"It is with great satisfaction that we an- 
nounce this truly valuable compilation, as 
the most complete and interesting treatise 
on Popular Medicine ever presented to the 
public. Simple and unambitious in its 
language, free from the technicalities, and 
embracing the most important facts on Ana- 
tomy, Physiology and Hygiene, or the 
art of preserving health; and the treatment 
of those affections which require immediate 
attention, or are of an acute character, this 
should be in the hands of every one, more 
particularly of those who, by their situations 
are prevented from resorting to the advice 
of a physician, nor would the careful peru- 

sal of its pages fail to profit the inhabitants 
of our cities, by giving them a more accu- 
rate knowledge of the structure of the hu- 
man frame, and the laws that govern ita 
various functions; whose perfect integrity 
is absolutely essential to health, and even 
to existence; the various systems of medical 
charlatanry, daily imagined to take advan- 
tage of the credulity and ignorance of man- 
kind, would be rendered far less prejudicial 
to the community than they now are. We 
would particularly direct attention to the 
Chapter on Hygiene, a science in itself of 
the utmost importance, and ably treated in 
the small space allowed to it in this vol- 
ume." — New York American. 


A Treatise on Pulmonary Consumption, 
comprehending an inquiry into the Nature, 
Causes, Prevention, and Treatment of Tu- 
berculous and Scrofulous Diseases in Ge- 
neral. By James Clark, M. D., F. R. S. 

As a text-book and guide to the inexpe- 
rienced practitioner we know none equal 
to it in general soundness and praptical 
utility — to the general as well as to the 
professional reader, the work will prove of 
the deepest interest, and its perusal of un- 
equivocal advantage." — British and Fo- 
reign Medical Review. 

" The work of Dr. Clark may be regard- 
ed as the most complete and instructive 
Treatise on Consumption in the English 
Language." — Edinburgh Medical and 
Surgical Journal. 


A Practical Treatise on Medical Juris- 
prudence, with so much of Anatomy, Phy- 
siology, Pathology, and the Practice pf 
Medicine and Surgery, as are essential to 
be known by Members of the Bar and Pri- 
vate Gentlemen; and all the laws relating 
to Medical Practitioners; with explanatory 
plates. By J. Chitty, Esq. Second Ame- 
rican edition: with Notes and Additions, 
adapted to American works and Judicial 
Decisions. 8vo. 

OF MEDICINE, or a Systematic Digest 
of the Principles of General and Special 
Pathology and Theraputics. By E. Ge^l- 
dings, (now preparing.) 




A Treatise on Fever. By Southwood 
Smith, M. D., Physician to the London 
Fever Hospital. Fourth American edition. 
In 1 volume 8vo. 


A Treatise on Dental Surgery. Second 
edition, revised, corrected, and improved, 
with new platees. By S. S, Fitch, M. D. 1 
vol. 8vo. 


Pathological and Practical Researches 
on Diseases of the Brain and Spinal 
Cord. Second American, from the third 
Edingburgh edition, enlarged. By John 
Abercrombie, M. D. In 1 volume 8vo. 


Pathological and Practical Researches 
on Diseases of the Stomach, the Intestinal 
Canal, the Liver, and other Viscera of the 
Abdomen. By John Abercrombie M. D., 
third American from the second London 
edition enlarged. In 1 vol. 8vo. 

The Anatomy, Physiology, and Diseases 
of the Teeth. By Thomas Bell, F. R. S., 
F. L. S. &c., third American edition. In 
1 vol. 8vo. With numerous plates. 


T,he Medical Companion or Family Phy- 
sician: treating of the Diseases of the 
United States, vt'ith their symptoms, causes, 
cure, and means of prevention. 


A Treatise on Diseases of the Heart and 
Great Vessels. By J. R. Bsrtien. Edited 
by G. Bouillaud. Translated from the 
French. 8vo. 


A Rational Exposition of the Physical 
Signs of Diseases of the Lungs and Pleura; 
Illustrating their Pathology and facilitating 
their Diagnosis. By Charles J. Williams, 
M. D. In 8vo. with plates. 


Physiological Pyretology; or a Treatise 
on Fevers, according to the Principles of 
the New Medical Doctrine. By F. G. 
Boisseau, Doctor in Medicine of the Facul- 
ty of Paris, &c. &c. From the fourth 
French edition- Translated by J. R. Knox, 
M.D. 1vol. 8vo. 


Manual of the Physiology of Man; or a 
concise Description of the Phenomena of 
his Organization. By P. Hutin. Trans- 
lated from the French, with notes, by J. 
Togno. In 12mo. 

VOLUMES, OCTAVO. Embracing. 

I. The Adaptation of External Nature 
to the Moral and Intellectual Constitution 
of Man. By the Rev. Thomas Chalmers. 

II. The Adaptation of External Nature 
to the Physical Condition of Man. By 
John Kidd, M. D., F. R. S. 

III. Astronomy and General Physics, 
Considered with References to Natural 
Theology. By the Rev. Wm. Whewell. 

IV. The Hand: Its Mechanism and 
Vital Endowments as Evincing Design. 
By Sir Charles Bell, K. H., F. R7 S. With 
nurtierous wood cuts. 

V. Chemistry, Meteorology, and the 
Function of Digestion. By Wm. Prout, 
M. D., F. R. S. 

VI. The History, Habits and Instincts 
of Animals. By the Rev. Wm. Kirby, M. 
A., F. R. S. Illustrated by numerous En- 
gravings on Copper. 

Vil. Anatomy and Vegetable Physiology 
Considered with Reference to Natural 
Tiieology. By Peter Mark Roget, M. D. 
Illustrated witii nearly Five Hundred 
Wood Cuts. 

VIII. Geology and Mineralogy, Con- 
sidered with Reference to Natural Theo- 
logy. By the Rev. Wm. Buckland, D. D. 
with nuratTous engravings on copper, and 
a large coloured map. 

%* The work of Buckland, Kirby and 
Rojet may bo had separate. 








Now publishing hy Lea ^ Blanchard, Philadelphia^ and for sale hy all Booksellers. 

The design of this work is to supply the want, generally admitted 
to exist in the medical literature of Great Britain, of a comprehensive 
System of Medicine, embodying a condensed, yet ample, view of 
the present state of the science. This desideratum is more especially 
felt by the Medical Student, and by many Members of the Profession, 
who, from Iheir avocations and other circumstances, have not the 
opportunity of keeping pace with the more recent improvements in 
the most interesting and useful branch of human knowledge. To 
supply this deficiency, is the object of The Library of Medicine; 
and the Editor expresses the hope, that with the assistance with 
which he has been favored by Contributors, (many of great eminence, 
and all favorably known to the Public,) he will be enabled to produce 
a work, which, when completed, vvill form a Library of general 
Reference on Theoretical and Practical Medicine, as well as a Series 
of Text Books for the Medical Student. 

It is intended to treat of each Department, or Division of Medicine, 
each Series forming a complete Work on the subject treated of, 
v/hich may be purchased separately at a very moderate price, or it 
will constitute a Part of The Library of Medicine. This arrange- 
ment is made with the view of giving those persons who may wish 
to possess one or more of the Series, the opportunity of purchasing 
such Volumes only, and thus avoid the inconvenience of making a 
larger addition to their stock of Books than their wants or circum- 
stances may require. 

Each Treatise will be authenticated by the Name of the Author; 


and from the care bestowed in the arrangements, it is confidently 
hoped, that the want of uniformity noticed in works of a similar kind, 
will be obviated, at least, as far as is compatible with the execution 
of the work by a numerous body of united Authors. 

The First Series will comprehend Practical Medicine. The Second 
Practical Surgery. The Third will include Midwifery, the Diseases 
of Women, and the Diseases of Children, &c. 

The other Departments of Medical Science will be treated of in 
successive Volumes. 

A work of this description is a greater desideratum in this country 
than even in Great Britain, from the great number of country prac- 
titioners here who have not access to libraries, and whose circuit 
of practice is so extensive as to afford little leisure for consulting 
elaborate treatises. To supply it the republication of the Library 
has been undertaken and the first volume is now presented to the 
American medical public. Should sufficient encouragement be 
afforded, the subsequent volumes will appear in quick succession. 

The American Publishers invite particular attention to the fact, 
that each volume is complete in itself, and will be sold separately: 
the acquisition of any one will not, therefore, necessitate the purchase 
of the others. The whole will, however, form a complete Medical 

Should it be hereafter deemed expedient, such notes or additions 
as may seem to be required will be supplied for the subsequent vol- 

The second volume, which has been received, is devoted to the 
Diseases of the Nervous System, and embraces the following sub- 
jects: — 

On the Pathology of the Nervous System, by Dr. Bennett. In- 
flammation of the Brain, by Dr. Hope. Hydrocephalus and Apo- 
plexy, by Dr. Bennett. Insanity, by Dr. Prichard. Delirium Tre- 
mens, Cephalalgia, Epilepsy, Catalepsy and allied affections. Spinal 
Meningitis, Inflammation of Spinal Cord, Hydrorachis, and Spinal 
Apoplexy, by Dr. Bennett. Chorea and Hj^steria, by Dr. Theophilus 
Thompson. Tetanus and Hydrophobia, by Dr. Bennett. Neuralgia, 
by Dr. Theophilus Thompson. Paralysis and Barbiers, by Dr. Ben- 
nett. Inflammation of the Eye, and Amaurosis, by Dr. Taylor. In- 
flammation of the Ear, by Dr. Bennett. 





INTRODUCTION. {Dr. St/monds.) 

General Observations on the Nature of Disease. — Principles of Association of morbid 
Phenomena. — Symptoms and Signs. — Causes. — Investigation of the most simple Forms 
of Disease. — General Pathology. — Arrangement — Diseases of the Capillary System.— 
I. Disordered Circulation. — Congestion. — Local Ansemia. — Inflammation. — Hsemorrhage. 
— II. Diseased Secretion — Fibrinous— ^Serous — Purulent. — Heterologous Formations — 
Tuberculous — Carcinomatous — J^Ielanotic — Gaseous. — III. Diseased Nutrition.— Hyper- 
trophy. — Atrophy. — Softening.- — Induration. — Transformation. — Ulceration.— Mortifica- 
tion. — Diseases of the Blood. — Plethora. — Ansemia. — Cachsemia. — Diseases of Nerves 
and contractile Fibres. — General Observations. — Hypersesthesia. — Ansesthesia. — Dysses- 
thesia. — Spasm. — Paralysis. — Neurotic Diathesis. 

INFLAMMATION. {Dr. Alison,) 

General View of the Phenomena of Inflammation. — Present State of our Knowledge of its 
essential Nature. — Causes. — Anatomical Characters. — General View of the Symptoms. — 
Varieties and Complications. — Modes of fatal Termination. — Outline of the Treatment 
of Inflammation, particularly in internal Parts. 


General Doctrines of Fever. {Dr. Ckristison,) 

Definition. — Forms of Fevers. — Local Diseases in Fever. — Theories respecting the Nature 
of continued Fever.— Exanthematous or eruptive Fevers. — Classifications of Fevers. 

CONTINUED FEVER. {Dr. Ckristison.) 

Symptoms of continued Fever. — Secondary Aff^ections. — Afi^ections of the Head — of the 
Throat — of the Chest — of the Abdomen — of the Skin. — Sequelse. — Relapse. — Partial 
Rheumatism and Neuralgia. — Partial Palsy. — CEdema. — Acute febrile Inflammations.— 
Supervention of Phthisis Pulmonalis. — Mania — Prevalence, Duration, and Mortality. — 
Anatomical Characters. — Causes. — Prognosis. — Treatment. — Prophylaxis. 

PLAGUE. {Dr. Shapter.) 

Characteristic Symptoms. — Varieties — Simple or Glandular — Eruptive — Malignant — Se- 
quela and Complications. — Anatomical Characters. — Diagnosis. — Prognosis. — Statistics. 
— Nature. — Causes. — Prophylactic Measures. — Treatment. 


Characteristics of Intermittent Fever. — Premonitory or forming Stage. — Symptoms of the 
Paroxysm. — The cold Stage. — The hot Stage. — The sweating Stage. — Apyrexial Period. 
— -Anomalous Symptoms occasionally observed in the different St-ages and in the Inter- 
vals. — Circumstances which determine the Type or Form of Tntermittents. — Description 
of the Quotidian Intermittent — of the Tertian — of the Quartan. — Deviations from the 
ordinary Course of the Paroxysm. — Modifications of Type — Inflammatory — Congestive — 
Malignant. — Complication of Intermittents with local Afifections. — Gastric Complication. 
— Cerebral Complication. — Pulmonary Complication. — Cardiac Complication. — Syncopal 
or Fainting Ague. — Splenic Complication. — Diagnosis. — Prognosis, — Terminations. — 
Anatomical Characters. — Numerical Statement of the Frequency of Lesions. — Statistics. 
— Nature. — Exciting Causes. — Treatment. 


REMITTENT FEVER. (Dr. Shapter.) 

Nomenclature.— Symptoms which characterise the simple Form. — Varieties — Bilio-Inflam- 
matory — Inflammatory — Malignant. — Complications. — Terminations. — Anatomical Cha- 
racters. — Diagnosis. — Duration. — Prognosis. — Nature. — Treatment. 

YELLOW FEVER. {Dr. Shapter.) 

Nomenclature. — Premonitory Symptoms. — Symptoms of the first Stage — of the second — of 
the third. — ^Inflammatory Form. — Adynamic Form. — Malignant or Congestive Form.— 
Terminations. — Anatomical Characters. — Statistics. — Prognosis. — Diagnosis. — Nature. — 
Causes. — Treatment. 


Division into the Acute and the Chronic Forms. — Symptoms of Complications of the acute 
Form. — Causes. — Diagnosis. — Treatment. — Symptoms of the Chronic Form. — Complica- 
tions. — Treatment. 

HECTIC FEVER. {Dr. Christison.) 

Definition. — Symptoms. — Diagnosis. — Causes. — Treatment. 

SMALL POX. {Dr. Gregory.) 

Description and Varieties. — Variola benigna discreta. — Variola confluens. — Secondary 
Fever and its Consequences. — Cutaneous Inflammation. — ^Variolous Ophthalmia. — Cere- 
bral Complication.— Thoracic Complication. — Abdominal Complication. — Other acci- 
dental Complications. — Variola semiconfluens, — Variola corymbosa. — Variola maligna. — 
Variolse anomalse. — Variola confluens mitigata. — Variola varicelloides. — Febris variolosa 
sine Eruptione. — Diagnosis of Small-pox. — Prognosis. — Mortality. — Anatomical Charac- 
ters. — Causes. — Susceptibility of Small-pox. — Recurrent Small-pox. — Treatment. — Vac- 
cination — History and Progress of. — Phenomena of Vaccination. — Circumstances which 
influenced the Protecting Power of Cow-pox. 

MEASLES. {Dr. George Burrows.) 

Definition.— History. — ^Varieties. — ^Rubeola Vulgaris. — ^Rubeola sine Catarrho. — Rubeola 
Maligna. — Sequelse. — Anatomical Characters. — Diagnosis. — Prognosis. — Causes. — Treat- 
' ment. 

SCARLATINA or SCARLET FEVER. {Dr. George Burrows.) 

Characteristic Smptoms.— -Varieties. — Scarlatina simplex. — Scarlatina anginosa. — Scarla- 
tina maligna. — Scarlatina sine Exanthemate. — Sequelae. — Anatomical Characters. — Causes. 
—Diagnosis, Prognosis and Mortality. — Treatment. — Prophylaxis. 


General Observations on Puerperal Fevers. — Acute Puerperal Peritonitis. — Symptoms, 
Morbid Appeai-ances and Treatment. — Adynamic or malignant Puerperal Fever. — Symp- 
toms. — Morbid Appearances. — Treatment. — Puerperal Intestinallrritation and its Treat- 
ment. — False Peritonitis and its Treatment. — Nature of Puerperal Fever. — Predisposing 
Causes. — Milk Fever and its Management. 

DISEASES OF THE SKIN. {Dr. H. E. Schedel.) 

Definitions. — Classification. — Erythema. — Erysipelas. — Roseola. — Urticaria. — Eczema. — 
Herpes. — Scabies. — Miliaria. — Varicella. — Pemphigus. — Rupia. —Ecthyma. — Impetigo. 
— Acne. — Mentagra. — Porrigo. — Equinia. — Lichen. — Prurigo. — Psoriasis. — Pityriasis. — 
Ecthyosis. — Lepra Tuberculosa. — Lupus. — MoUuscum. — Frambsesia. — Cheloidea. — Len- 
tigo. — Ephelides. — Nsevi and Vitiligo. — Purpura. — Pellagra. — Radesyge.— Lepra Astra- 
chanica. — Malum Alepporum. — Elephantiasis Arabica. — Syphilitic Eruptions or Syphi- 




A New Series of this Journal will commence with the next Number, which, 
will be published January Is^, 1841. These changes, it is believed, will be 
agreeable to the friends of the Work. The commencement of a New Series will 
afford an opportunity to many to subscribe to the Journal, who are anxious to do 
so, but are unwilling to possess an incomplete series, or to purchase so many 
back volumes. The extent also to which this work has now reached, 52 Nos., 
renders the cost of the whole greater than many young physicians are able to incur; 
and further, some of the Numbers are nearly exhausted and in a short time com- 
plete copies cannot be furnished. 

The change in the months of publication is made in order to obviate the mis- 
conceptions and confusion that has frequently arisen from the year of the Journal 
having hitherto commenced with the November Number. No Number will con- 
sequently be issued before the 1st of January next, which will be the commence- 
ment of a new year. 

The Journal will continue under the same editorial management as heretofore, 
and no change will be made in its aim or principles, but such improvements will 
be introduced into the plan as the enlarged experience of the editor and his able 
colleagues may suggest. 

The great object proposed in the institution of this Journal was to establish a 
National Work, devoted exclusively to the improvement of Medical Science, and to 
the elevation of the character and dignity of the profession, to the entire rejection of 
all local and individual interests and party views. To accomplish this, a number 
of the most distinguished men in various parts of the Union associated, and have 
contributed to its pages the rich results of their experience. The object aimed at 
has been attained, and this Journal is regarded by the great mass of the American 
medical profession as their representative, and as such is received and quoted 

The first part of each Number consists of original memoirs and cases, in the 
selection of which those of a practical tendency have always the preference. 

The department of Monographs which has given so much satisfaction will be 
continued, and every effort made to increase its interest and usefulness by the 
selection of subjects of practical importance. Monographs on scarlet fever, laryn- 
gitis, bronchitis, and other important diseases are in preparation. 

The Reviews and Bibliographical Notices, present critical and analytical ac- 
counts of the principal works, domestic and foreign. In this department entire 
freedom of criticism is allowed, always however, marked by candour, and in that 


courteous tone which alone comports with the true dignity of science. The ar- 
ticles are always authenticated by the writer's signature, which, as it secures to 
him the credit of his labour, affords a stimulus to perform it well, and at the 
same time subjecting him to the responsibility of authorship, affords a security 
against hasty opinions. The editor also exercises the strictest watchfulness over 
these departments, to exclude all personalities and undue harshness of expression, 
and to prevent the influence of personal friendships or private enmities. 

The Summary contains a condensed digest of the discoveries and improve- 
ments in every branch of the healing art, and as the means at the disposal of 
the editor are unusually ample, this department is particularly useful and interest- 
ing. We are happy to announce that Dr. T. R. Beck, well known as the author 
of one of the best works on Medical Jurisprudence extant, will contribute to this 
department a summary of all the discoveries and improvements in the important 
branch to which he has devoted so much attention. 

The period of publication will be Quarterly as hitherto, as this is believed to 
possess great advantages, in allowing of the insertion of elaborate and comprehen- 
sive memoirs entire, which can not be inserted in a weekly journal of small size, 
or if published, could only be so in detached pieces, which destroys their interest 
and impairs their value. It affords also time to compare the tarious accounts of dis- 
coveries, and thus to select the best and most authentic. The very extensive corres- 
pondence of the editor, and the numerous journals he receives, with the arrange- 
ments that are made to have them forwarded by the speediest conveyances, enables 
him to give early intelligence of every novelty. 

Established on a broad and liberal foundation, and favoured by the support of 
many of the most distinguished men in every part of the Union, this Journal will 
continue to be devoted exclusively to upholding the dignity and advancing the 
great interests of the profession. 

Practitioners in every part of the Union, disposed to aid in the advancement of 
Medical Science, are invited to contribute the results of their Experience. All 
articles inserted will be liberally paid for, and such persons as are disposed to aid 
in the circulation of the work, are requested to hand this prospectus among their 
medical friends. 

The subscription will be Jive dollars a year, payable always in advance,- any person 
forwarding twenty dollars, can have jive copies of the work forwarded as they may 
direct. Each number will contain about 264 large and closely printed pages as 
heretofore, illustrated when necessary with cuts and engravings, and published 
quarterly, on the first of January, April, July and October. 

Subscribers who may be in arrears, are urged to forward the amount of their 
dues, that the new series may be continued to them, it being the intention of the 
publishers not to send to such persons as are tardy in their remittances. Such 
subscribers as wish to commence with the new series, will see the advantage of 
forwarding their names early, for but few will be printed over the number sub- 
scribed for. 

Philadelphia, August \st, 1840. 






Elisha Bartlett, M. D. Professor of 
Pathological Anatomy in the Berkshire 
Medical Institution. 

Jacob Bigelow, M. D. Professor of Ma- 
teria Medica in Harvard University, 

A. Brigham, M. D. of Hartford, Con- 

N. Chapman, M. D. Professor of the 
Institutes and Practice of Physic and 
Clinical Practice in the University of 

B. H. CoATES, M. D. one of the Physi- 
cians to the Pennsylvania Hospital. 

Reynell Coates, M. D. of Philadel- 

D. Francis Condie, M. D. of Philadel- 

William P. Dewees, M. D. Late Pro- 
fessor of Midwifery in the University 
of Pennsylvania. 

S. Henry Dickson, M. D. Professor of 
the Institutes and Practice of Medicine 
in the Medical College of the State of 
South Carolina. 

Gouverneur Emerson, M. D. of Phi- 

Charles Evans, M. D. Attending Phy- 
sician to the Friends'' Asylum, Frank- 

John D. Fisher, M. D. of Boston. 

E. Geddings, M. J). Professor of Patho- 
logy and Medical Jurisprudence in the 
Medical College of the State of South 

William Gibson, M. D. Professor of 
Surgery in the University of Pennsyl- 

R. E. Griffith, M. D. late Professor of 
Medicine in the University of Virgi- 

Thomas Harris, Surgeon U. S. Navy, 
and one of the Surgeons of the Penn- 
sylvania Hospital. 

E. Hale, M. I). Physician to the Mas- 
sachusetts General Hospital. 

George Hayward, M. D. Professor of 
the Principles of Surgery and Clinical 
Surgery in Harvard University , Bos- 

Hugh L. Hodge, M. D. Prof, of Mid- 
wifery in the University of Penn. 

T. S, KiRKBRiDE, M. D. of Philadelphia. 


C. A. Lee, M. D. of New York. 

Samuel Jackson, M. jy.Professorofthe 
Institutes of Medicine in the University 
of Pennsylvania. 

Samuel Jackson, M. D. Philadelphia. 

William E. Horner, M. D. Professor 
of Anatomy in the University of Penn- 

Valentine Mott, M. D. Professor <f 
Pathological and Operative Surgery in 
the College of Physicians and Surgeons, 
New York. 

Reuben D. Mussey, M. D. Professor of 
Surgery in the Medical College of Ohio. 

T. D. Mutter, M. D. Lecturer on Sur- 

G. W. Norris, M. D. one of the Sur- 
geons to the Pennsylvania Hospital. 

R. M. Patterson, M. D. Late Prof essor 
of Natural Philosophy in the University 
of Virginia. 

C. W. Pennock, M. D. one of the Phy- 
sicians to the Philadelphia Hospital, 

R. R. Porter, M. D. Late Resident 
Physician to the Friends' Asylum, 

Thomas Sewall, M. D. Professor of 
Anatomy and Physiology in the Co- 
lumbian College, District of Columbia. 

Ashbel Smith, M. D. Ex-surgeon Gene- 
ral of the Texan Army. 

Nathan R. Smith, Professor of the 
Practice of Medicine in Transylvania 

Thomas Stewardson, M. D. one of the 
Physicians to the Pennsylvania Hos- 

A. F. Vache, M. D. of New York. 

John Ware, M. D. Professor of the 
Theory and Practice of Physic in 
Harvard University , Boston. 

John C. Warren, M. D. Professor of 
Anatomy and Surgery in Harvard 
University, Boston. 

Edward Warren, M. D. of Boston. 

John Watson, M. D. of New York. 

G. B. Wood, M. D. Professor of Ma- 
teria Medica and Pharmacy in the Uni- 
versity of Pennsylvania. 

Thomas H. Wright, M. D. Late Phy- 
sician to the Baltimore Alms-house In- 

TOR— Isaac Hays, M. D., one of the Surgeons to Wills'' Hospital for the 
Blind and Lame, ^c. 


We invite attention ta the advertisement of the Publishers, announcing 
a Neio Series of this v^^ork to commence with the next Number. Advan- 
tage will be taken of this event to make whatever improvements our ex- 
perience or the wishes of our friends have suggested, and others will from 
time to time be introduced as the advancement of science, and changes in 
the condition of the profession may require them. Promises as to the 
conduct he will adopt are unnecessary from the editor of this Journal. 
He refers to the past as the best guarantee for the future. It is sufficient 
to say that the course he has hitherto pursued and which has gained for 
the Journal its high character and extensive circulation, and established its 
claim both at home and abroad as a National Work, will continue to be 
undeviatingly followed. Maintaining as our exclusive aim the great inte- 
rests of the profession and the promotion of the holy cause of truth and 
science, this Journal will be solely devoted to the honour and advance- 
ment of professional reputation and usefulness unshackled by sectional, 
party or personal feelings. 

The profession in every part of the union are deeply interested in the 
character and success of this work, and they are invited to record in its 
pages the results of their experience. 

The following works have been received: — 

Transactions of the Medical Society of the State of New York, vol. iv. 
(From the Society.) 

Practical Observations on the Causes and Treatment of Curvatures of the 
Spine, with hygienic directions for the physical culture of youth as a means of 
preventing the disease; an etching and description of an apparatus for the cor- 
rection of the deformity; and engravings illustrative of the cases. By Samuel 
Hare, Surgeon. London, 1838. (From the Author.) 

A System of Practical Medicine comprised in a series of original disserta- 
tions. Arranged and Edited by Alexander Tweedie, M.D., F,B.S., &c., &c. 
Rudiments of General Pathology, Inflammation, Fevers, and Diseases of the 
Skin. Philadelphia: Lea & Blanchard, 1840. (From the Publishers.) 

An Essay on the Means of Improving Medical Education and Elevating Med- 
ical Character. By A. Boardman, M. D. Philadelphia, 1840. (From the 

The Salt Sulphur Springs, Monroe County, Virginia. By Thomas D. Mut- 
ter, M. D., &c. &c. &c. Philadelphia, 1840. (From the Author.) 

An Introductory Lecture delivered at the opening of the Medical Department 
of the Columbian College, November 4, 1834. By John Frederick May, M. 
D., Professor of Anatomy and Physiology. (From Dr. Sewall.) 

Twenty-third Annual Report on the state of the Asylum for the relief of per- 
sons deprived of their Reason. Philadelphia, 1840. (From Dr. Pliny Earle.) 

An Introductory Address before the Students and Trustees of the Vermont 
Academy of Medicine, delivered at the opening of that Institution. Castleton, 
March 11, 1840. By Horace Green, A. M., M. D., of New York, President 
and Professor of Theory and Practice of Medicine. (From the Author.) 



Annual Catalogue of the Officers, Students and Graduates of the Medical In- 
stitute at Louisville, for 1839-40. 

Proceedings of the President and Fellows of the Connecticut Medical Society 
in Convention May 1840, v^^ith a list of the Members of the Society. Hartford, 
1840. (From Dr. Welsh.) 

An Introductory Lecture to a course on the Principles and Practice of Surgery, 
delivered in the Vermont Academy of Medicine, March 12, 1840. By James 
Bryan, M. D., Professor of Surgery, &c., &c. 1840. (From the Author.) 

Catalogue of the Trustees, Faculty and Students of the Vermont Academy of 
Medicine for the session of March, 1840. (From the Same.) 

A Catalogue of the Officers and Students of Jefferson Medical College of 
Philadelphia. Session, 1839-40. (From Prof. Huston.) 

Instructions and Observations concerning the use of the Chlorides of Soda 
and Lime. By A. G. Labanaque. Translated by Jacob Porter, Member of 
the Am. Antiq. Soc. &c. &c. Third edition. New Haven, 1840. (From the 

Treatise on the Physiological and Moral Management of Infancy. By An- 
drew Combe, M. D., &c. &c. &c., with notes and a supplementary chapter by 
John Bell, M. D., &c. &c. Philadelphia, Carey & Hart, 1840. (From the 

Medical and Physiological Commentaries. By Martin Paine, M. D., A. M. 
In two Volumes. New York and London, 1840. (From the Author.) 

The Maryland Medical and Surgical Journal. April, 1840. (In Exchange.) 

Report of the Commissioners, appointed by the Governor of New Jersey, to 
ascertain the number of Lunatics and Idiots in the State. Submitted to the 
Legislature on the 26th February, 1840. Newark, 1840. (From Dr. L. Condict, 
Chairman of the Commissioners.) 

A System of Medical Etiquette, Rules and Regulations, as adopted by the 
Medical Association of North- Western Kentucky. Maysville, 1839. (From 
the Association.) 

The British and Foreign Medical Review, or Quarterly Journal of Practical 
Medicine and Surgery. April, 1840. (In Exchange.) 

The Edinburgh Medical and Surgical Journal. April, 1840. (In Exchange.) 

The Medico-Chirurgical Review and Journal of Practical Medicine. April 
1840. (In Exchange.) 

The London Medical Gazette. 1840. (In Exchange.) 

The India Journal of Med. and Phys. Sciences. Jan. 1840. (In Exchange.) 

Revue Medicale Francaise et Etrangere. Jan. and Feb. 1840. (In Exchange.) 

Gazette Medicale de Paris, February and March, 1840. (In Exchange.) 

Journal de Medecine et de Chirurgie Pratiques. February and March, 1840. 
(In Exchange.) 

Journal des Connaissanees Medico-Chirurgicales. February and March, 1840. 
(In Exchange.) 

Journal des Connai'ssances Medicales Pratiques et de Pharmacologic. Febru- 
ary and March, 1840. (In Exchange.) 

La Lancette Frangaise Gazette des Hopitaux Civils et Militaires. January, 
February and March, 1840. (In Exchange) 

Journal de Pharmacie. January February, and March, 1840. (In Exchange.) 

The American Journal of Pharmacy for April, 1840. (In Exchange.) 

The Boston Medical and Surgical Journal for May, June and July, 1840. 
(In Exchange.) 

The American Medical Library and Intelligencer for May and June, 1840. 
(In Exchange.) 

The Medical Examiner for May and June, 1840. (In Exchange.) 

The Select Medical Library, and Eclectic Journal of Medicine, for May, June 
End July, 1840. (In Exchange.) 

The Western Journal of Medicine and Surgery. June, 1840. (In Exchange.) 
The four preceding numbers of this Journal have n6t reached us. 





I. Report of Cases treated in the Wills Hospital for the Blind and Lame 
during the months of October, November and December, 1839, with 
Observations. By Isaac Hays, M. D., one of the Surgeons. - - - 277 

II. A Recto- Vaginal Fistula— Cured. By J. Rhea Barton, M. D. - - 305 

III. Case of Twins, simulating Superfcetation, with Remarks. By Isaac 

G. Porter, M. D., of New London, Conn. 307 

IV. Observations on the lodo-hydrargyrate of Potassium. By Charles C. 
Hildreth, M. D., of Zanesville, Ohio. 312 

V. Observations on the Pathology and Treatment of Intermittent Fever. 

By J. F. Peebles, M. D., of Petersburg, Va. 323 

VI. Observations on the Benefits of a particular mode of Bloodletting, and 
of large doses of Opium in the treatment of the Acute Phlegmasise. 

By Thomas Barbour, M. D., of La Grange, Alabama. . - . 330 

VII. History of a case of Catalepsy — occurring in a boy at the age of fif- 
teen years. By Isaac Parrish, M. D. - - - - - - - 337 

VIII. Cases of Fever, resembling Dothinenteritis or the Typhoid Affection, 
with Remarks. By Jno. M. B. Harden, M. D., of Liberty County, 
Georgia. 346 

IX. Case of Calculus in the Bladder — Lithotomy — Death. By Thos. F. 
Betton, M. D., of Germantovvn, Pa. 353 

X. Case of Strangulated Hernia, complicated by the presence of the Testi- 
cle in the Abdominal Canal. By Paul F. Eve, M. D., Professor of Sur- 
gery in the Med. Col. of Georgia. _.__--. 355 


XL Observations on the Operative Procedures employed for the Relief of 
Procidentia Uteri; with Cases, in which this displacement was reme- 
died by suture of the external labia, (episioraphy.) By E. Geddings, 
M. D., Prof, of Pathology and Medical Jurisprudence in the Medical 
College of the State of South Carolina. 357 

XII. On Diseases of the Foetus: a contribution towards a better acquaint- 
ance with Intra-uterine Pathology. By Wm. C. Roberts, M. D., of 

New York. 369 

Bibliography. By Editor. ----.- = -- 399 





XII. Elements of Pathological Anatomy, illustrated by numerous Engra- 
vings. "In morbis, sive acutis, sive chronicis, viget occultum, per hu- 
manas speculationes fere incomprehensible." — Baglivi. By Samuel D. 
Gross, M. D., late Professor of General Anatomy, Physiology, and 
Pathological Anatomy, in the medical department of the Cincinnati Col- 
lege. 2 vols. Boston: Marsh, Capen, Lyon, and Webb, and James B. 
Dow, 1839: pp. 519 and 500, 8vo. 401 


XIII. The Library of Medicine, being a System of Practical Medicine, 
comprised in a series of Original Dissertations. Arranged and edited by 
Alexander Tweedie, M. D., F. R. S. Fevers, Inflammation and Diseases 

of the Skin, Bvo. pp. 561. Philadelphia: 1840. 422 

XIV. An Essay on the Subject of the Yellow Fever, intended to prove its 
Transmissibility. By B. B. Strobel, M. D., Late Physician of the 
Charleston Marine Hosp'ital. "Audi alteram partem." 8vo. pp. 224. 
Charleston: 1840. 429 

XV. Narrative of the Discoveries of Sir Charles Bell in the Nervous Sys- 
tem. By Alexander Shaw, Assistant Surgeon in the Middlesex Hospi- 
tal. 8vo. pp. 232. London: 1839. 431 

XVII. Memoranda for Practitioners in Midwifery. By Edward Rigby, M. 
D., &c. First American edition, with additions. By S. C. Foster, M. 
D., Licentiate of the Dublin Lying-in Hospital, &c. 18mo. pp. 63. 
New York: 1840. - - - - 432 

XX. Principles of Political Economy. Part the Third; Of the Causes 
which retard increase in the numbers of Mankind. Part the Fourth; Of 
the Causes which retard improvement in the Political Condition of Man. 
By H. C. Carey, Author of an Essay on the Rate of Wages. Philadel- 
phia, 1840, 8vo. pp. 270. Lea & Blanchard. 433 

XXI. Medical and Physiological Commentaries. By Martin Paine, M. 

D., A. M. 2 vols. 8vo. pp. 716 and 815. New York: 1840. - -437 
XXIII. Practical Observations on the causes and treatment of Curvatures 
of the Spine. By Samuel Hare, Surgeon, pp. 151, 8vo. London: 
1838. 438 




Anatomy and Physiology. 

i. Nerves of the Cornea. By M. 

Hippolyte Cloquet. - - 439 
a. On the Injurious Qualities of 

Menstrual Blood and its Proba- 


ble Causes. By Dr. Remak of 
Berlin. - . - - 439 

3. A portion of a Fostus living 




upon the testicle. By M. Vel- 
peau. ----- 440 

4. Cases of Twins where one had 
been long dead. ByDr. C.Th. 

V. Siebold, of Dantzic. - 442 

5. Transposition of the Thoracic 
and Abdominal Viscera, accom- 
panied with an unusual Variety 
in the Venous System. By A. 

M. M. Whinnie. - - - 443 

6. Lateral Transposition of the 
Abdominal Organs alone. By 
Mr. Curling. - - - 444 

7. On the Sympathy between the 
Cerebellum and the Testes. By 
Dr. J. Budge. - - - 445 

8. Growth of the Hair. By M. 
Mandl. - - . - 446 

9. Experiments on the Motor and 
Sensitive Roots of the Nerves. 
By Dr. Kronenberg, of Mos- 
cow. ----- 446 

10. Case of a woman pregnant 
with five children. By Dr. 
Every Kennedy. - - - 447 

Pathological Anatomy and General Pathology. 

11. Remarkable Case of Ischuria 
Renalis, of Nine Years' Stand- 
ing, with Vicarious Vomitilg of 
Urine. By F. L. Kreysig, M. 

D., of Dresden. - - - 448 

12. On the Causes of Scrofulous 
Disease. By M. Lugol. - 449 

13. Case of Disease of the Poste- 
rior Columns of the SpinaJ 

Cord. By Edward Stanley, 
Esq. 450 

14. Spontaneous Rupture of the 
Spleen. By Dr. Naeckel. - 451 

15. On the various Circumstances 
which appear in the course of 
Diseases, to produce the curved 
form of the Nails. By M. Ver- 
nois. - . - - - 451 

Materia Medica and General Therapeutics. 

16. Effects and mode of applica- 
tion of Suppositories. By Dr. 
Osborne. - - - - 452 

17. Belladonna in flying Rheuma- 
tic Pains. By Jonathan Os- 
borne, M. D., of Dublin. - 453 

18. Emetics of Ipecacuan in Hae- 
morrhage. By Dr. Osborne. 453 

19. Thread Setons. By Dr. Os- 

borne, of Dublin. - 


20. On the Employment of the Ac- 
tive Principle of Elaterium in 
Medicine. By Dr. Golding 
Bird. - - - - - 454 

21. Action of Ergot applied exter- 
nally — its power in arresting 
Haemorrhage. By Samuel 
Wright, Esq. - - - 454 

Special Pathology and Special Therapeutics. 

22. Nervous Headache from Ex- 
haustion, and its Treatment with 
Aconite. By Thomas H. Bur- 
gess, M. D. - - - 455 

23. Memoranda on the Treatment 

of Apoplexy. By Dr. Jourdain. 456 

24. Epidemic Aphthous Inflam- 
mation of the Mouth. By Dr. 
Girelli. - - - - 459 

25. On the distinction between 
Typhus Fever and Dothinente- 
rie. By N. C. Barlow, M. D. 460 

26. Plastic Bronchitis treated by 
Mercury. By Dr. Cane. - 464 

27. Abscess between Pharynx and 
Spine. By Dr. Fleming. - 465 

28. Neuralgic Pains of the Abdo- 
men after parturition simulating 
puerperal peritonitis. By Dr. 
Golding Bird. - - - 468 

29. On the Morbid Consequences 
of Undue Lactation. By Samuel 
Ashwell, M. D. - - - 469 

30. Acetate of Lead in Bronchitis. 

By Dr. William Henderson. 474 

31. Clinical Researches on Ty- 
phoid Fever in Children. By 
Dr. C. Taupin. - - - 475 



32. Complete Absence of the Iris. 
By Dr. F. Prael. - 

33. Formation of New Eyelids. 
By Dr. E. Laborie. 

34. Apoplexy of the Eyes. By 
Dr. Holscher. - - - 

35. Amaurosis — softening of the 
Optic Nerves through their en- 





tire substance and length — soft- 
ening of the Thalami. By Dr. 
Alexander Kilgour. - - 478 
36. Cure of Squinting by Division 
of the Internal straight Muscle 
of the Eye. By Prof. DiefFen- 
bach, of Berlin. - - - 478 


37. Efficacy of cold water, in a de- 
scending douche, for old ulcers 
of the feet. By Dr. Butzke of 
Schwetz. - - - - 480 

38. Treatment of Gonorrhoea by 
frequent injections of a weak 
solution of Sulphate of Zinc. 480 

39. Incontinence of Urine, during 
sleep, in Females. By E. W. 
Duffin, Esq. - - -481 

40. Case of Gun-shot Wound, in 
which the Patella was carried 
away, and the Knee-joint com- 

pletely laid open, successfully 
treated. By W. Ward, Esq. 481 

41. Case of Dislocation of the 
Shoulder-joint, with Fracture of 
the Hjimerus. By J. A. Hinge- 
ston. 482 

42. Practical Hints on the Treat- 
ment of Strictures. By Brans- 

by B. Cooper, Esq. - - 484 

43. Aneurism of the Arteria Inno- 
minata — Ligature of Carotid and 
Subclavian Arteries. By W. 
Wickham, Esq. - - - 488 


44. EfFecffe of Parturition on the 
Nervous System of the Mother. 
By Dr. Churchill. 

45. On the Influence of Digitalis 
on the Contractions of the Ute- 
rus. By M. Piedagnel. 

46. Case of Metritis with Epilep- 
sy, in which Separation and Ex- 
pulsion of a great part of the. 
Vagina and of the Neck of the 
Uterus, followed by recovery. 



took place. By Dr. Antonio 
Longhi. - - - - 492 

47. Case of Impacted Head, with 
great subsequent loss of Parts. 

By M. Cazenave, of Bordeaux. 493 

48. Retroversion of the Ut